Regional anaesthetic technique for laparoscopic appendicectomy in Ibadan.

Background: Laparoscopy is now readily being deployed for abdominal surgeries in our centre, thanks to the surgeons' interest and the desire to follow best practice as obtained in other climes. General anaesthesia (GA) with intermittent positive pressure ventilation is usually the preferred mode of anaesthesia for this procedure. There are reports of laparoscopic surgery of abdomen performed under spinal and or epidural anaesthetic techniques.

Methods: With Intra-Abdominal Pressure (IAP) from CO2 insufflations limited to 10-12 mmHg, Laparoscopic Appendicectomy (LA) was performed under Combined Spinal Epidural (CSE) for ten consenting ASA 1 and II patients with mean age 23.6 years and BMI of 24.9 kg/m2 in University College Hospital Ibadan, Nigeria. Intra-operative events and ease of operation were studied; systemic drugs were administered if patients complained of pain and discomfort, and G.A if regional techniques and sedation failed.

Results: Eight(8) patients had the procedure completed under spinal anaesthesia supplemented with sedation, two (2) patients whose block went as high as T4 had no need of sedation. There were operative difficulties in four patients out of which 2 had sedations and the surgeons could continue operating. We converted to GA in two (2) patients when regional techniques and sedation failed.

Conclusion: We concluded that with proper selection of patients and limiting IAP to 10-12 mmHg, LA can be safely performed with spinal anaesthesia with some supplementation.