Multimodal anaesthetic strategy in a case of acute cholecystitis: Sensorcaine-based spinal block with sedation

Abstract

Background: Acute cholecystitis commonly necessitates laparoscopic cholecystectomy, often requiring general anaesthesia. However, in elderly patients, a multimodal approach using regional anaesthesia with sedation may offer superior hemodynamic stability, reduced systemic drug load, and enhanced recovery outcomes. This case highlights such a strategy using Sensorcaine (heavy Bupivacaine) and Butorphanol for spinal block, supplemented by short-acting intravenous anaesthetic agents. Case Presentation: A 60-year-old female presented with right upper quadrant abdominal pain, vomiting, and dyspepsia. Ultrasonography confirmed cholelithiasis with features of acute cholecystitis. The patient was planned for laparoscopic cholecystectomy. Anaesthetic Technique: Combined spinal anaesthesia using heavy Sensorcaine (Bupivacaine) and Butorphanol was administered. Sedation and general support were provided using Inj. Midazolam and Butorphanol for premedication. Induction was achieved using Propofol, Succinylcholine, and Atracurium. Anaesthesia was maintained with oxygen, intermittent Atracurium, and Propofol infusion. Reversal was done using Neostigmine and Atropine. Intraoperative Course: Surgery lasted approximately 90 minutes. Vital parameters remained stable (BP ~120/80 mmHg, SpO₂ 98-100%). Intraoperative findings included adhesions between the gallbladder and omentum, which were carefully dissected. Drain placement was performed. No intraoperative complications occurred. Outcome: The patient regained full consciousness postoperatively with stable hemodynamics and good pain control. Recovery was smooth with early ambulation and minimal need for systemic opioids. Conclusion: Spinal anaesthesia with sedation is a viable multimodal strategy in selected cases of laparoscopic cholecystectomy for acute cholecystitis, especially in geriatric patients. It ensures effective anaesthesia, minimal stress response, and faster postoperative recovery.