Comparison of the Effectiveness and Safety of Segmental Thoracic Spinal Anesthesia Using Isobaric Levobupivacaine 0.5% Versus Hyperbaric Levobupivacaine 0.5% in Performing Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial

Introduction: Laparoscopic cholecystectomy has evolved into a daycare procedure thanks to advancements in both surgical and anesthetic techniques. Regional anesthesia, specifically segmental thoracic spinal anesthesia (TSA), offers distinct benefits over general anesthesia, such as enhanced hemodynamic stability and quicker recovery, especially in high-risk patients. This study aims to compare the sensory and motor block characteristics, hemodynamic stability, and incidence of adverse effects between isobaric and hyperbaric 0.5% levobupivacaine in segmental TSA for laparoscopic cholecystectomy.

Methodology: A prospective, randomized, double-blind trial was conducted from May to August 2024 at GSVM Medical College, Kanpur. A total of 60 patients, classified as American Society of Anesthesiologists (ASA) I and II, scheduled to undergo elective laparoscopic cholecystectomy, were randomly assigned to two groups, with 30 patients in each group. This randomization process was conducted after obtaining ethical approval and registering the study with the Clinical Trials Registry of India (CTRI). Group B received 1.5 mL of hyperbaric 0.5% levobupivacaine with 25 mcg fentanyl via TSA at the T10-T11 interspace, while Group A received 1.5 mL of isobaric 0.5% levobupivacaine with 25 mcg fentanyl. Various parameters, including hemodynamic changes, adverse effects, satisfaction scores, maximum sensory block height, and the onset and duration of both sensory and motor blocks, were recorded. Postoperative pain was assessed using the visual analog scale (VAS).

Results: Group B demonstrated higher levels of sensory and motor block, with a faster onset, leading to superior surgical conditions and higher patient satisfaction scores. Group A, on the other hand, not only experienced a longer block duration but also reported more negative side effects, including bradycardia and hypotension, which led to higher postoperative discomfort. Hemodynamic analysis showed that throughout the early time points (2-8 minutes), Group A had a considerably lower heart rate and systolic and diastolic blood pressure.

Conclusions: Hyperbaric levobupivacaine provided faster block onset and offset, improved satisfaction, better hemodynamic stability, and quicker recovery. It is a safe and effective anesthetic choice for laparoscopic cholecystectomy, offering predictable block spread and fewer adverse effects compared to isobaric levobupivacaine.