الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
general anesthesia (GA) was the traditional anesthetic technique for laparoscopic cholecystectomy. But advancement of laparoscopic surgery to involve high risk patients with multiple co-morbidities encouraged the investigators to seek other anesthetic modalities for it. So in this study we compare between general anesthesia and epidural anesthesia for laparoscopic cholecystectomy as regard effect on hemodynamics, post operative analgesia and complications related to surgery and anesthesia. Aim of the work: to compare epidural anesthesia versus general anesthesia as regard intraoperative hemodynamics and postoperative pain control for laparoscopic cholecystectomy as well as the anticipated complications. Methods: Eighty patients belonging to physical status I or II according to American Society of Anesthesiologists (ASA), aged between 20 to 60 years old undergoing laparoscopic cholecystectomy, were enrolled. They were randomly divided into 2 equal groups. In group (G) patients received general anesthesia. Induction was done with propofol (2–3 mg/kg), fentanyl citrate (2 μg/kg), and atracurium besylate (0.5 mg/kg). Balanced anesthesia was continued with isoflurane 1–2%. While patients of group (E) received epidural block at the 10th thoracic interspace using 17 gauge Tuohy needle and median approach. The epidural space was identified using the “loss of resistance” to air method. The hemodynamic changes intraoperative and post operative were monitored, also onset and duration of the sensory and motor blocks were monitored and evaluated using the pinprick and Bromage scale. Assessment of the postoperative pain was done using numeric pain rating scale (NPRS). Results: there was no significant differences regarding the demographic data and the mean duration of surgery of the investigated patients of the two groups (P >0.05). There was hypotension and bradycardia among patients of group (E) in early period intraoperatively with significant differences. Also postoperative pain was less among patients of group (E), but there was also a high incidence of shoulder pain in group (E) patients with significant differences. Conclusion: The present results indicated that general anesthesia is better anesthetic technique for elective laparoscopic cholecystectomy (LC). However epidural anesthesia is also efficacious and provided effective postoperative analgesia. But success of the technique necessitates relaxed and co-operative patient and gentle surgical procedure with low intra-abdominal pressure technique.