Selective spinal anesthesia for outpatient laparoscopy. V: Pharmacoeconomic comparison vs general anesthesia

Purpose: To compare the cost and effectiveness of small-dose spinal anesthe sia (SP) with general anesthesia (GA) for outpatient laparoscopy. Methods: A retrospective record analysis of 24 patients who received SP wer e compared with 28 patients who received GA in our Daycare centre, The cost s of anesthesia and recovery were calculated, from an institutional perspec tive, using 1997 Canadian Dollar values. Effectiveness was measured in term s of time for anesthesia and recovery, and postoperative antiemetic and ana lgesic requirements. Results: Both groups were well matched for age, weight, duration and type o f surgery. The mean total cost for the SP group of $53.45 +/- 10.40 was no different from that for the GA group of $48.92 +/- 10.25 (95% Cl - 10.3, 1. 2). Time to administer anesthesia was longer in the SP group with a mean ti me of 18 +/- 8 min compared with 10 +/- 3 min in the GA group (Cl - 11.3, - 4.7). Recovery time in the PACU was longer in the SP group 123 +/- 51 min c ompared with 94 + 48 min (Cl -56.6,- 1.4). Postoperative antiemetic require ments were similar: 8% in SP group vs 14% in GA group, whereas analgesic re quirements were less in the SP group with 25% receiving analgesia compared with 75% in the GA group (P < 0.05). Conclusion: The total cost of anesthesia and recovery using SP is similar t o that for GA when used for outpatient laparoscopy. Spinal anesthesia was l ess effective than GA in time to administer anesthesia and in duration of r ecovery. Postoperative analgesic requirements were reduced using SP.