Pulmonary Function and Pain Relief after Laparoscopic Gastric Banding Performed Under Combined General Epidural Anesthesia in Morbidly Obese Patients

Background: Recovery from general anesthesia might be compromised in morbidly obese patients due to increased the risk of postoperative hypoxaemia and pulmonary complications, particularly after abdominal surgery. This study was carried out to compare the effect of general anesthesia andcombined general epidural anesthesia in laparoscopic gastric banding to control postoperative pain, their effect on pulmonary functions and recovery time.Methods: Thirty adult patients aged 20-33years, ASA status I-II, undergoing elective laparoscopic gastric banding for treatment of morbid obesity. They were divided randomly into 2 equal groups according to anesthesia received. Group I (n=15) received combined general cervical epidural anesthesia and group II (n=15) received general anesthesia alone. Subjective pain relief was assessed by visual analogue scale. Pulmonary functions were assessed by forced vital capacity,forced expiratory volume in 1st second and peak expiratory flow rate (FVC, FEV1 and PEFR).Results: Pulmonary function tests were better in group I than group II at first and six hours postoperatively. FVC, FEV1 and PEFR were reduced significantly in group II than in group I (forced vital capacity was reduced by 42% compared with 30%, forced expiratory volume in 1st second was reduced by 43% compared with 31% and peak expiratory flow rate by 12% compared with 8% respectively).Pain severity during mobilization and on coughing was significantly less in group I than in group II as evidenced by less VAS scores. Also, the narcotic consumption was less in group I. Postoperative recovery time was shorter in group I than in group II. (Times to extubation were 6±lmin, 13±8min respectively).Conclusion: It was concluded that: Combined general epidural anesthesia, in morbidly obese patients had less postoperative pain and more preservation of pulmonary functionsafter laparoscopic gastric banding.