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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2018 Mar 07

DOI: 10.23736/S0375-9393.18.12557-0


lingua: Inglese

Effectiveness of spinal anaesthesia in transanal endoscopic microsurgery: a 3-years experience

Gerardo CORTESE 1, Gabriele SALES 2, Giorgia MAIOLO 2, Mario MORINO 2, 3, Martina SCANU 2, Luca BRAZZI 1, 2

1 Department of Anesthesia, Intensive Care and Emergency, "Città della Salute e della Scienza" Hospital, Turin, Italy; 2 Department of Surgical Sciences, University of Turin, Turin, Italy; 3 Department of Surgery, "Città della Salute e della Scienza" Hospital, Turin, Italy


BACKGROUND: The feasibility and safety of transanal endoscopic microsurgery (TEM) performed under spinal anaesthesia (SA) has been recently demonstrated. This retrospective study compared the differences in opioid consumption and postoperative recovery in patients undergoing TEM under GA and SA.
METHODS: All consecutive patients who underwent TEM at ‘Città della Salute e della Scienza’ hospital of Turin (Italy) between January 2012 and December 2015 were enrolled. Data related to demographic characteristics, surgery, anaesthesia management and postoperative course were recorded from the hospital electronic registry of medical records. Patients were treated according to a standardized protocol by a team of three anaesthesiologists with experience in both GA and SA.
RESULTS: The study included 148 patients: 77 in GA group and 71 in SA, with no switch among groups. Hospital length of stay was shorter in SA group (3 vs 4 days, p=0.0201). SA patients were earlier mobilized and applied to oral postoperative intake (18 vs 24 hours and 24 vs 48 hours, respectively, p<0.0001). Peri-procedural complications, postoperative nausea, vomiting and pain were comparable between groups. Percentage of patients requiring postoperative rescue therapy with Tramadol was similar between groups, but SA patients received a lower opioid dosage (176.6±67.8 mg vs 238.3±79.5 mg, p=0.0011). Operating room occupancy times was longer in GA group (120 vs 100 minutes, p=0.0008).
CONCLUSIONS: SA seems to be the treatment of choice, when not contraindicated, in patients undergoing TEM, allowing a reduction in perioperative opioid consumption and a faster postoperative recovery.

KEY WORDS: General anaesthesia - Spinal anaesthesia - Transanal endoscopic surgery - Pain management - Perioperative care

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Publication History

Article first published online: March 7, 2018
Manuscript accepted: March 6, 2018
Manuscript revised: February 7, 2018
Manuscript received: November 10, 2017

Per citare questo articolo

Cortese G, Sales G, Maiolo G, Morino M, Scanu M, Brazzi L. Effectiveness of spinal anaesthesia in transanal endoscopic microsurgery: a 3-years experience. Minerva Anestesiol 2018 Mar 07. DOI: 10.23736/S0375-9393.18.12557-0

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