Appendicectomy under Local Anaesthesia

SURGICAL TECHNIQUE

Appendicectomy under Local Anaesthesia Lal B. Sharma, Mudit Agarwal, Lalit Chaudhary and Vijay K. Shukla From the Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi – 221005, India

Eur J Surg 1999; 165: 1091–1092 ABSTRACT Objective: To analyse our results of appendicetomy under local anaesthesia. Design: Prospective study. Setting: University hospital, India Subjects: 165 patients who presented with appendicitis between January 1996 and December 1997. Intervention and main outcome measures: Appendicectomy after infiltration of local anaesthetic. No patient required general or spinal anaesthesia. Result: Five patients (3%) developed postoperative wound infections. Mean operating time was 20 minutes (range 15–30) and median hospital stay 2 days (range 1–3) Conclusion: Appendicectomy under local anaesthesia is quick, cost-effective and carries little morbidity. It can be safely used for all age groups. Key words: local anaesthesia, appendicitis, appendicectomy, lignocaine.

PATIENTS, METHODS AND RESULTS We prospectively studied 165 patients whose appendicitis was operated on under local anaesthesia in one surgical unit of the University Hospital, Varanasi, India, from January 1996 to December 1997. All patients with appendicitis were included except those who refused operation under local anaesthesia or were operated on for other conditions. Plain abdominal radiograph and ultrasound were done for all patients, but fertile women were not routinely laparoscoped. Body mass index (BMI) was calculated for each patient (kg/m2) as was the approximate cost of the hospital stay. TECHNIQUE OF LOCAL ANAESTHESIA We used 1% lignocaine with 1/200 000 adrenaline infiltrated beneath the proposed area of incision and then diffusely into the deeper fascial layers; this was augmented by infiltration of the extraperitoneal space when reached. All patients were monitored intraoperatively.

Adequate anaesthesia was achieved in all the patients. Eight patients for whom interval appendicectomy had been planned were found to have ileocaecal tuberculosis (n = 3) or ovarian cyst (n = 5), and they were operated on under local anaesthesia but not included in the study. No patient required conversion to general or spinal anaesthesia and no patient developed signs of toxicity. Details of the patients are given in Tables I and II. Local anaesthesia was much cheaper than general or spinal.

DISCUSSION Local anaesthesia has been steadily refined since its introduction by Koller in 1884 (4) and is now widely used in several surgical specialties (1, 3, 5). We have shown that appendicectomy under local anaesthesia is cost-effective and carries low morbidity and no mortality. Non-compliance is the most important contraindication, and there is limited access for exploration. The reasons usually quoted when local

Table II. Details of patients.

Table I. Age and sex distribution Age (years)

Male (n = 90)

Female (n = 75)

Total (n = 165)

0–20 21–40 41–60

37 (41) 48 (53) 5 (6)

28 (37) 41 (55) 6 (8)

65 (39) 89 (54) 11 (7)

1999 Scandinavian University Press. ISSN 1102–4151

Data are expressed as mean (range) except where otherwise stated. BMI Duration of operation (min) No (%) of wound infection Duration of hospital stay (days)

20 (18–24) 20 (15–30) 5 (3) 2 (1–3) Eur J Surg 165

1092 L. B. Sharma et al. anaesthesia is under-used are fear of failure, the time taken for induction, and fear of neurological complications. The systemic toxic effects of local anaesthesia are related to the blood concentrations of specific agents, which in turn are regulated by the rate of vascular absorption, tissue distribution, metabolism, and excretion. We recommend appendicectomy under local anaesthesia for the reasons given and it can safely be used in all age groups.

3. Howard CB, Mackie IG, Fairclough J, Austin TR. Femoral neck surgery using a local anaesthetic technique. Anaesthesia 1983; 38: 993–994. 4. Koller C. On the use of cocaine for producing anaesthesia on the eye. Lancet 1884; ii: 990–992. 5. Sinha CKR, Gupta DK, Gopal SC, Gangopadhyay AN, Sharma SP. Surgical procedures under local anaesthesia and sedation (LASE) in neonates and children. Indian J Surg 1998; 50: 23–26.

REFERENCES

Submitted June 29, 1998; submitted after revision October 8, 1998; accepted November 25, 1998

1. Dennison A, Oakley N, Appleton D, et al. Local anaesthesia for major general surgical procedures: review of 116 cases over 12 years. Postgrad Med J 1996; 72: 105–108. 2. Dennison AR, Watkins RM, Ward ME, Lee ECG. Simple mastectomy under local anaesthesia. Ann R Coll Surg Engl 1985; 67: 243–244.

Address for correspondence: V. K. Shukla, M.D. Department of Surgery Institute of Medical Sciences Banaras Hindu University Varanasi – 221005 India

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