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Selective spinal anesthesia for outpatient laparoscopy. V: Pharmacoeconomic comparison vs general anesthesia

Colin R. Chilvers, B MED DA (US) FANZCA^*, Alison Goodwin, MB FCA^*, Himat Vaghadia, MB BS MHSC FRCPC FFARCS^*, and G.W.E. Mitchell, MB CHB FRCOG FRCS(ed) FRCSC

^* From the Departments of Anaesthesia,
Health Care and Epidemiology, and
Gynaecology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence to: Dr. Himat Vaghadia, Department of Anaesthesia, Room 3200, Vancouver General Hospital, 3rd Floor – 910 West 10th Ave, Vancouver, BC, V5Z 4E3 Canada. Phone: 604-875-4575; Fax: 604-875-5209; E-mail: vaghadia{at}interchange.ubc.ca

Purpose: To compare the cost and effectiveness of small-dose spinal anesthesia (SP) with general anesthesia (GA) for outpatient laparoscopy.

Methods: A retrospective record analysis of 24 patients who received SP were compared with 28 patients who received GA in our Daycare centre. The costs of anesthesia and recovery were calculated, from an institutional perspective, using 1997 Canadian Dollar values. Effectiveness was measured in terms of time for anesthesia and recovery, and postoperative antiemetic and analgesic requirements.

Results: Both groups were well matched for age, weight, duration and type of surgery. The mean total cost for the SP group of $53.45 ± 10.40 was no different from that for the GA group of $48.92 ± 10.25 (95% CI –10.3,1.2). Time to administer anesthesia was longer in the SP group with a mean time of 18 ± 8 min compared with 10 ± 3 min in the GA group (CI -11.3, -4.7). Recovery time in the PACU was longer in the SP group 123 ± 51 min compared with 94 ± 48 min (CI –56.6,-1.4). Postoperative antiemetic requirements were similar: 8% in SP group vs 14% in GA group, whereas analgesic requirements were less in the SP group with 25% receiving analgesia compared with 75% in the GA group (P < 0.05).

Conclusion: The total cost of anesthesia and recovery using SP is similar to that for GA when used for outpatient laparoscopy. Spinal anesthesia was less effective than GA in time to administer anesthesia and in duration of recovery. Postoperative analgesic requirements were reduced using SP.

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