Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia?

Luigi Della Corte; Maria Chiara Guarino; Michela Dell'Aquila; Mario Ascione; Serena Guerra; Rossella De Rosa; Annaclaudia Del Piano; Dario Bruzzese; Giuseppe Bifulco; Pierluigi Giampaolino

doi:10.1159/000535778

Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia?

Gynecol Obstet Invest. 2024;89(1):41-49. doi: 10.1159/000535778. Epub 2023 Dec 13.

Affiliations

¹ Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
² Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy.
³ Department of Anesthesiology and Intensive Care Medicine Policlinico - Federico II University Hospital, Naples, Italy.

PMID: 38091962
DOI: 10.1159/000535778

Abstract

Introduction: Minimally invasive procedures performed in laparoscopy, such as salpingectomy for ectopic pregnancy, can be combined with a minimally invasive anesthesia. The aim of this study was to assess the feasibility and the intraoperative and postoperative outcomes of laparoscopic surgery for ectopic pregnancy under spinal anesthesia (SA) compared to general anesthesia (GA) from the point of view of the surgeon, anesthesiologist, and patient.

Methods: A retrospective cohort study was performed at DAI Materno Infantile of AOU Federico II of Naples, analyzing all medical records of women who met the inclusion criteria between April 2020 and April 2023. Eighty-two women (35 under SA in group A and 47 under GA in group B) undergone elective or emergency laparoscopic salpingectomy for ectopic tubal or ovarian pregnancy were included.

Results: Patients in group A reported less pain at 0 h (adjusted mean difference: -1.5; 95% CI: -2.3 to -0.7; p < 0.001) and after 6 h (adjusted mean difference: -1.1; 95% CI: -2.0 to -0.3; p = 0.01) while no statistically significant differences between the two groups at 12 and 24 h after surgery. No differences were observed among the type of analgesic and during the postoperative observation time, except for paracetamol at 0 h in group B. A faster resumption of bowel motility, patient's mobilization, and a shorter hospital stay were observed in group A compared to group B. Also greater odds of returning faster to daily activities emerged in group A (adjusted OR: 5.39; 95% CI: 1.77-16.37). A greater number of patients in group A were satisfied with the entire procedure compared to those of group B (33 [94.3%] vs. 37 [78.7%]). The general surgeon satisfaction was always very good or excellent in group A. Finally, all surgical steps were well tolerated in group A.

Conclusion: In specific settings, SA is a feasible and safe procedure for the laparoscopic treatment of ectopic pregnancy.

Keywords: Ectopic pregnancy; Laparoscopy; Minimally invasive anesthesia; Minimally invasive surgery; Spinal anesthesia.

MeSH terms

Anesthesia, General / methods
Anesthesia, Spinal* / methods
Female
Humans
Laparoscopy* / methods
Pregnancy
Pregnancy, Ectopic* / etiology
Pregnancy, Ectopic* / surgery
Retrospective Studies