Combined general and neuraxial anesthesia versus general anesthesia alone for laparoscopic cholecystectomy: a meta-analysis of pain control and hemodynamic stability.

Abstract

Combined general and neuraxial anesthesia (CGNA) is an alternative technique that may enhance intraoperative outcomes and reduce postoperative pain in patients undergoing laparoscopic cholecystectomy. In this meta-analysis, we aimed to compare the perioperative outcomes of CGNA with those of general anesthesia alone. A systematic search of PubMed, Cochrane, Scopus, Web of Science, and gray literature was conducted from inception to July 2024. We evaluated postoperative pain at 2, 4, 6, and 12 h after surgery using the Visual Analogue Scale. Intraoperative outcomes, including systolic, diastolic, and mean arterial pressure, were assessed at the 30-minute mark during surgery. Data analysis was performed using R software. Quality assessment was carried out using Cochrane's risk of bias tools. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to describe the certainty of our findings. We meta-analyzed nine studies, encompassing a total of 724 patients. The analysis of postoperative pain revealed a significant reduction at 2, 4, 6, and 12 hours in the combined general and neuraxial anesthesia group, with the most pronounced effect occurring within the first four hours. Hemodynamic parameters showed a significant difference only in mean arterial pressure at 30 min during surgery, based on sensitivity analysis and the inclusion of only randomized controlled trials. Other vital signs, as well as the duration of surgery, anesthesia time, and rates of postoperative nausea and vomiting, were comparable between the two groups. A combined general and neuraxial anesthetic approach may improve postoperative pain relief and minimize hemodynamic stress during laparoscopic cholecystectomy and pneumoperitoneum-induced stress.