Feasibility and Safety of Performing Laparoscopic Cholecystectomy Under Subarachnoid Block (SAB): A Prospective Clinical Study

Background: Laparoscopic cholecystectomy (LC) is commonly performed under general anesthesia; however, the use of subarachnoid block (SAB) as a regional anesthetic technique offers potential benefits, including reduced opioid use and faster recovery. Objective: To assess the feasibility and safety of performing laparoscopic cholecystectomy under SAB, focusing on anesthetic outcomes, intraoperative hemodynamics, postoperative pain, recovery time, and complications. Methods: This prospective clinical study was conducted at Barind Medical College, Rajshahi, from June 2023 to June 2024, involving 72 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned to either SAB or general anesthesia. The SAB group received 0.5% bupivacaine heavy at the L3-L4 intervertebral space. Primary outcomes measured were intraoperative hemodynamic stability, postoperative pain scores (using the Visual Analog Scale), recovery time, and complications (hypotension, bradycardia, respiratory depression). Data were analyzed using SPSS, with a significance level set at p < 0.05. Results: In the SAB group, 85.7% of patients experienced stable hemodynamics, with an average systolic blood pressure decrease of 15 mmHg (± 3.2 SD), and a heart rate reduction of 10 bpm (± 4.1 SD). Postoperative pain scores were significantly lower in the SAB group (3.1 ± 1.4) compared to the general anesthesia group (5.7 ± 2.0, p < 0.01). Recovery time was reduced by 30%, with the SAB group having an average recovery time of 4.5 hours (± 1.2 SD). Intraoperative complications, such as hypotension (12%) and bradycardia (9%), were lower compared to the general anesthesia group, where the incidence of hypotension was 25% and bradycardia 18%. Standard deviation for recovery times was 1.2 hours for SAB compared to 2.0 hours for the general anesthesia group. Additionally, the p-value for postoperative opioid consumption was 0.02, indicating a significant reduction in opioid use in the SAB group. A detailed analysis showed a significant reduction in nausea and vomiting episodes (p < 0.05) in the SAB group. Conclusion: Subarachnoid block is a feasible and safe anesthetic alternative for laparoscopic cholecystectomy, offering superior postoperative recovery, reduced opioid requirements, and fewer complications compared to general anesthesia.