Dr. Comandur Lavanya,
BACKGROUND Diagnostic Hysterolaparoscopy (DHLS) is routinely done under general anaesthesia which is costly and is associated with many complications. To overcome these complications and make the procedure cost-effective, a study of DHLS as a day care surgery under spinal anaesthesia (SA) was conducted. No. 27 Quincke needle was used which has minimal or no Post Dural Puncture Headache (PDPH). 1% Chloroprocaine given intrathecally is a short acting ester local anaesthetic with no side effects. Lastly, intravenous nalbuphine is a non-narcotic analgesic used to counter shoulder and neck pain due to pneumoperitoneum. METHODS 100 ASA grade-I females posted for DHLS were studied. After preloading with 500 ml of DNS, SA was given with 4 cc of 1% Chloroprocaine at L2-3 level in lateral position using No. 27 Quincke needle. 30o head-low given to achieve a block of T3-4 level. Intravenous nalbuphine 0.4 mg/Kg was given. Supplemental oxygen was given through polymask. The sensory and motor blocks were assessed by pinprick method and modified Bromage scale. Vital signs were monitored. Occurrence of intra-operative and post-operative side effects were recorded. The time taken to achieve post anaesthesia discharge score of 12 was recorded. Patients were followed for 48 hrs for any side-effects and patient satisfaction score was recorded. RESULTS The onset time was rapid (sensory block 5.8±2.2 min). The mean time of 2-segment recession of spinal block, taken as duration of anaesthesia, was 38.3±6.195 min which was sufficient as the duration of surgery was 31.36±5.46 min. The intraoperative conditions were excellent with minimal & treatable intraoperative side effects. Mild chest heaviness was seen in all patients due to pneumoperitoneum in head low position. The time of PADS of 12 (252±36 min) showed that patients were ready for discharge in 5 hrs. PDPH was seen in 16 patients on 1st day & 4 patients on 2nd day. Patient satisfaction was good (t = 4.09). CONCLUSIONS DHLS under SA with 1% Chloroprocaine offers rapid onset, excellent intraoperative conditions with minimal intra & postoperative morbidity, rapid recovery and good patient satisfaction, thus making it a cost effective procedure.
