LAPAROSCOPIC APPENDECTOMY UNDER SPINAL ANESTHESIA IN SUB-SAHARAN AFRICA: A CASE SERIES REPORT joeltochie@gmail.com

PW03-03

LAPAROSCOPIC APPENDECTOMY UNDER SPINAL ANESTHESIA IN SUB-SAHARAN AFRICA: A CASE SERIES REPORT

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Cameroon

Oral only

Introduction: Following systematic review’s evidence from Asian and North African populations on the safety – effectiveness profile of spinal anesthesia (SA) for laparoscopic appendectomy, we assessed the feasibility and safety of these in sub-Saharan Africa (SSA) where it is currently not routine. This study is a preliminary step towards the conduct of clinical trials on this research question in sub-Saharan Africa.

This was a chart review of six adult Cameroonian patients ASA I – II, who underwent laparoscopic appendectomy under low-pressure pneumoperitonium ≤12 mmHg, trendelenburg position ≤15° and spinal anesthesia using hyperbaric bupivacaine 0.5% 12.5 mg, fentanyl 25ug, morphine 100ug injected intrathecally at L3 – L4 or L4 – L5 space. We reviewed intraoperative and postoperative complications, as well as postoperative pain intensity using the Numerical rating scale.

All six patients had T6 sensory block, duration of laparoscopic appendectomy was 52 - 86 mins with no conversion to general anesthesia required. Intraoperatively, stable mean arterial pressures, pulses (with only few ephedrine boli needed in some cases) and SpO2 were observed with no complication but for one case of tolerable shoulder pain. All had mild postoperative pain and resumed walking within 20h (table 1).

Spinal anesthesia for laparoscopic appendectomy in sub-Saharan Africa has shown a promising success rate on this case review, with stable hemodynamic and respiratory profiles, reduced complications and postoperative pain. Large prospective multicenter studies are warranted to better explore these merits in sub-Saharan Africa.