Spinal—General Anaesthesia Decreases Neuroendocrine Stress Response in Laparoscopic Cholecystectomy

OBJECTIVE: A randomized clinical study to compare the stress response to laparoscopic cholecystectomy during spinal—general anaesthesia and epidural—general anaesthesia. METHODS: Women undergoing elective laparoscopic cholecystectomy were assigned to receive either spinal anaesthesia (SA group; n = 12) or epidural anaesthesia (EA group; n = 12), in addition to general anaesthesia. Plasma concentrations of cortisol, adrenocortico trophic hormone (ACTH), noradrenaline, adrenaline and total catecholamines were measured pre- and intraoperatively. RESULTS: Intraoperative cortisol, noradrenaline and total catecholamine levels were significantly lower in the SA group compared with the EA group. When pre- and intraoperative values were compared, the SA group showed a decrease in adrenaline, noradrenaline and total catecholamine levels, and the EA group showed an increase in ACTH and noradrenaline levels. CONCLUSIONS: The type of regional anaesthesia significantly affected the stress response: spinal anaesthesia produced a more favourable endocrine response than epidural anaesthesia. Spinal—general anaesthesia may reduce postoperative morbidity in laparoscopic cholecystectomy.