الفهرس 
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Abstract
This prospective comparative study was conducted in Minia Maternity University Hospital after obtaining Institutional Ethical Committee approval and written informed consent from all patients. A total of 105 female patients, belonging to ASA grade I and II, aged between 45-65 years, and scheduled to undergo Laparoscopic hysterectomy were included in the study. Patients who refused to participate in the study, presented with known allergy to any of the study drugs or with contraindications to neuraxial anesthesia, with severe cardiac, pulmonary, or neurological diseases, drug abuse or on analgesics for any reason, or patients in whom surgery had to be converted to open hysterectomy were excluded from the study.
The patients were divided into three groups by computer-generated random allocation, having 35 patients each.
group S-GA: received spinal combined with general anesthesia.
group E-GA: received epidural combined with general anesthesia.
group GA: received general anesthesia.
Intraoperatively, cardiovascular parameters (including MAP and HR) and SpO2 were recorded at post induction, postintubation, at creation of pneumoperitoneum and during surgical manipulation (every 5 min.), at release of CO2 insufflation and at extubation. Any incidence of hypo¬tension, bradycardia, or hypertension was noted.
Consumption of isoflurane, analgesics or nitroglycerine infusion was documented. Recovery time, VAS score at recovery and time for 1st analgesic request were recorded. The operative field assessed by the surgeon was graded as excellent, good or poor. Incidence of postoperative complications was noted.
The Result of this research revealed that there were no significant differences in patient characteristics, duration of surgery or pneumoperitoneum among the three groups.
S-GA and E-GA groups showed stable hemodynamic parameters (MAP and HR) at pneumoperitoneum and during surgical manipulation, compared with GA group. However, MAP decreased significantly at postinduction in groups S-GA and E-GA, compa.
Intraoperatively, consumption of isoflurane, opioid, and nitroglycerine infusion was higher in group GA than in other two groups (P < 0.05). Episodes of hypotension was more frequent in S-GA and E-GA groups, whereas hypertension occurred more frequently in GA group. The operative field was significantly better in S-GA and E-GA groups than in GA group. Groups S-GA and E-GA exhibited better pain scores at recovery and had faster recovery and longer postoperative analgesia , compared with GA group. Incidence of postoperative adverse events was low and comparable in the three groups.
We concluded that Regional anesthesia, either spinal or epidural, combined with general anesthesia was an effective for attenuation of the hemodynamic stress response associated with peumoperitoneum, without increasing side effects, in patients undergoing laparoscopic hysterectomy. Moreover, it provided better operative field, less consumption of anesthetics, analgesics or vasodilators, faster recovery, longer postoperative analgesia. However, it caused significant transient reduction of MAP after induction of GA, which was properly managed without any adverse outcome.