Impact of Anesthetic Protocols on Surgical Outcomes in Laparoscopic Gynecological Procedures Performed by General Surgeons
Keywords:
Laparoscopy, Gynecological Surgery, Anesthesia Techniques, Postoperative Pain, and PONVAbstract
The general surgeon has performed more laparoscopic gynecological surgeries in recent times, especially where there has been a lack of gynecological services. Choice of anesthesia can affect postoperative pain, recovery, and safety during the operation. This present paper will investigate three modes of anesthesia in terms of the surgical results in the laparoscopic gynecological operation performed by general surgeons.
This cross-sectional study was conducted among 111 female patients, and assigned the patients to standard general anesthesia (GA; n = 42), GA with ultrasound-guided transversus abominis plane (TAP) block (n = 39), or multimodal opioid sparing total intravenous anesthesia (TIVA; n = 30). The main outcome was postoperative pain (measured using VAS) at 2, 6, and 24 hours. The secondary outcomes were include surgical time, blood loss, conversion to open surgery, complication rate, postoperative nausea and vomiting (PONV), need for pain relief, ambulation time, and length of hospital stay.
The outcomes of the study indicated that pain levels were lower in TAP block and TIVA than in standard GA, at 2 hours (3.6 ± 1.0 in TAP and TIVA vs 5.8 ± 1.4 in standard GA), as well as at other follow-up times (6 hours and 24 hours). The use of rescue analgesics was reported in 59.5% of patients in the standard GA group and only in 30.8% and 33.3% in the case of TAP block and TIVA, respectively. PONV occurred least frequently in patients on TIVA (6.7 vs 33.3 in the case of standard GA). Open conversions were observed in 14.3%, 10.3%, and 0% of examined patients, respectively.
Thus, the findings suggest that the use of regional anesthetic techniques, like TAP block, is more effective than modes of general anesthesia (like TIVA) and that it can keep patients free of the need in rescue analgesics.
References
1. V. Lerner, C. DeStephano, A. Ulrich, E. S. Han, E. LeClaire, and C. C. G. Chen, ‘A systematic review of validity evidence for the fundamentals of laparoscopic surgery examination in gynecology’, Journal of Minimally Invasive Gynecology, vol. 28, no. 7, pp. 1313–1324, 2021.
2. J. Stones and D. Yates, ‘Clinical risk assessment tools in anaesthesia’, BJA Education, vol. 19, no. 2, pp. 47–53, 2019.
3. J. H. Hwang and B. W. Kim, ‘Comparison of general anesthesia and combined spinal and epidural anesthesia for gasless laparoscopic surgery in gynecology’, JSLS: Journal of the Society of Laparoscopic and Robotic Surgeons, vol. 26, no. 2, pp. e2022-00004, 2022.
4. X. X. Wang et al., ‘Comparison of postoperative events between spinal anesthesia and general anesthesia in laparoscopic cholecystectomy: A systemic review and meta-analysis of randomized controlled trials’, BioMed Research International, vol. 2016, p. 9480539, 2016.
5. N. Zirak, F. Keshtan, M. Razavi, and others, ‘Comparison of spinal and general anesthesia in gynecologic diagnostic laparoscopy’, JPNC, vol. 19, no. 1, pp. 15–21, 2018.
6. L. Li, Y. Pang, Y. Wang, Q. Li, and X. Meng, ‘Comparison of spinal anesthesia and general anesthesia in inguinal hernia repair in adults: A systematic review and meta-analysis’, BMC Anesthesiology, vol. 20, no. 1, p. 64, 2020.
7. F. Tabatabaei and M. Masoumzadeh, ‘Dislocated intrauterine devices: Clinical presentations, diagnosis, and management’, The European Journal of Contraception and Reproductive Health Care, vol. 26, no. 2, pp. 160–166, 2021.
8. A. Peters, N. Siripong, L. Wang, and N. M. Donnellan, ‘Enhanced recovery after surgery outcomes in minimally invasive nonhysterectomy gynecologic procedures’, American Journal of Obstetrics and Gynecology, vol. 223, no. 2, p. 234.e1-234.e8, 2020.
9. O. Ljungqvist, M. Scott, and K. C. Fearon, ‘Enhanced recovery after surgery: A review’, JAMA Surgery, vol. 152, no. 3, pp. 292–298, 2017.
10. F. Celik and I. S. Edipoglu, ‘Evaluation of preoperative anxiety and fear of anesthesia using APAIS score’, European Journal of Medical Research, vol. 23, no. 1, p. 41, 2018.
11. D. Rutherford, E. M. Massie, C. Worsley, and M. S. Wilson, ‘Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy’, Cochrane Database of Systematic Reviews, no. 10, 2021.
12. P. Giampaolino et al., ‘Laparoscopic gynecological surgery under minimally invasive anesthesia: A prospective cohort study’, Updates in Surgery, vol. 74, no. 5, pp. 1755–1762, 2022.
13. D. Raimondo, G. Borghese, M. Mastronardi, M. Mabrouk, P. Salucci, and A. Lambertini, ‘Laparoscopic surgery for benign adnexal conditions under spinal anaesthesia: Towards a multidisciplinary minimally invasive approach’, Journal of Gynecology Obstetrics and Human Reproduction, vol. 49, no. 7, p. 101813, 2020.
14. H. Ohnesorge, V. Günther, M. Grünewald, N. Maass, and I. Alkatout, ‘Postoperative pain management in obstetrics and gynecology’, Journal of the Turkish German Gynecological Association, vol. 21, no. 4, pp. 287–297, 2020.
15. M. Qi et al., ‘Pre-incisional preventive precise multimodal analgesia may enhance the rehabilitation process of acute postoperative pain following total laparoscopic hysterectomy: A randomized controlled trial’, Pain Physician, vol. 26, no. 3, pp. E123–E131, 2023.
16. Z. Tavoli, Z. Asgari, F. Afshari, F. Tabatabaei, and A. Montazeri, ‘Recurrence rate of endometrioma after laparoscopic bilateral cystectomy and unilateral cystectomy and drainage in opposite side’, The Iranian Journal of Obstetrics, Gynecology, and Infertility, vol. 23, no. 3, pp. 19–25, 2020.
17. P. Giampaolino et al., ‘Role of ovarian suspension in preventing postsurgical ovarian adhesions in patients with stage III–IV pelvic endometriosis: A systematic review’, Journal of Minimally Invasive Gynecology, vol. 26, no. 1, pp. 53–62, 2019.
18. B. Kaya Uğur, L. Pirbudak, E. Öztürk, Ö. Balat, and M. G. Uğur, ‘Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study’, Turkish Journal of Obstetrics and Gynecology, vol. 17, no. 3, pp. 186–195, 2020.
19. B. K. Uğur, L. Pirbudak, E. Öztürk, and others, ‘Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study’, Turkish Journal of Obstetrics and Gynecology, vol. 17, no. 3, pp. 186–195, 2020.
20. N. Patel, K. Chaudhari, G. Jyotsna, and J. S. Joshi, ‘Surgical frontiers: A comparative review of robotics versus laparoscopy in gynecological interventions’, Cureus, vol. 15, no. 11, p. e49752, 2023.
