Laparoscopic appendectomy in adult patients: locoregional or general anesthesia? A meta-analysis

Background: Laparoscopic visceral resections under locoregional anesthesia are still debated. Aim of this study is to evaluate feasibility and effectiveness of regional anesthesia for laparoscopic appendectomy in adult patients. Methods: A PubMed-MEDLINE Embase, Cochrane Database and Google Scholar systematic review was carried out. Both primary and secondary endpoints were investigated. Relative risk for each item was pooled and no bias according to Cochrane Collaboration’s tool and funnel plot asymmetry test were found. Results: Four randomized controlled trials, including 280 patients, were enrolled. Regional anesthesia increased the risk of intraoperative arterial hypotension (RR: 8.00, P=0.048) without significant correlation with bradycardia (RR: 3.00, P=0.050). On the other hand, locoregional techniques statistically reduced the incidence of shoulder pain (RR: 0.35, P=0.023) and postoperative nausea and vomiting (RR: 0.18, P=0.024). Transient urinary retention was higher in this cohort without clinical relevance (RR: 11.00, P=0.103), butthese patients experienced a substantial reduction of postoperative pain in the immediate perioperative period (RA-VAS vs. GA-VAS: 1.17±0.39 vs. 4.83±0.70, P<0.001). Although hospital stay was similar (P=0.001), both time to mobilization and time to peristalsis resumption favoured the interventional brace (RA-LA vs. GA-LA: 11.75±1.75 vs. 16.60±2.70; P<0.001 and RA-LA vs. GA-LA: 6.95±1.50 vs. 7.85±2.35; P=0.011). Conclusions: Locoregional anesthesia laparoscopic appendectomies in adult patients are effective and safe, as being a valid alternative to general anesthesia not only for high-risk patients.