Laparoscopic cholecystectomy under spinal anaesthesia vs. general anaesthesia: a meta-analysis of randomized controlled trials

Background: Laparoscopic Cholecystectomy (LC) is conventionally performed under general anaesthesia (GA), but there are multiple studies which have found spinal anaesthesia (SA) as a safe alternative. This meta-analysis was performed after adding many recent randomized controlled trials (RCTs) to clarify this issue. Methods: Relevant articles published in English were identified by searching PubMed, Embase, Web of Knowledge, and the Cochrane Controlled Trial Register from January 1, 2000 to December 1, 2014. Reference lists of the retrieved articles were reviewed to identify additional articles. Primary outcomes (postoperative pain scores) and secondary outcomes (operating time (OT) and postoperative complications) were pooled. Quantitative variables were calculated using the weighted mean difference (WMD), and qualitative variables were pooled using odds ratios (OR). Results: Seven appropriate RCTs were identified from 912 published articles. Seven hundred and twelve patients were treated, 352 in SA group and 360 in GA group. LC under SA was superior to LC under GA in postoperative pain within 12 h (visual analogue score (VAS) in 2-4 h, WMD=-1.61, P = 0.000; VAS in 6-8 h, WMD=-1.277, P = 0.015) and postoperative complications (postoperative nausea and vomiting (PONV) WMD = 0.427, P = 0.001; Overall Morbidity WMD = 0.691, P = 0.027). The GA group was superior to SA group in postoperative urinary retention (WMD = 4.273, P = 0.022). There were no significant differences in operating time (WMD = 0.184, P = 0.141) between two groups. Conclusions: SA as the sole anaesthesia technique is feasible, safe for elective LC.