COMPARATIVE EVALUATION OF 0.5% ISOBARIC LEVOBUPIVACAINE AND 0.75% ISOBARIC ROPIVACAINE FOR SEGMENTAL SPINAL ANESTHESIA IN ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Background: General anesthesia remains the standard anesthetic technique for laparoscopic cholecystectomy; however, segmental spinal anesthesia has gained increasing acceptance as an effective alternative because of its advantages, including avoidance of airway manipulation, improved postoperative analgesia, reduced opioid requirement, and enhanced perioperative recovery. Levobupivacaine and ropivacaine are newer long-acting local anesthetics with improved cardiovascular safety compared with racemic bupivacaine, although comparative evidence regarding their effectiveness during segmental spinal anesthesia for laparoscopic cholecystectomy remains limited. Objectives: To compare the efficacy and safety of 0.5% isobaric levobupivacaine and 0.75% isobaric ropivacaine for segmental spinal anesthesia in patients undergoing elective laparoscopic cholecystectomy, with emphasis on sensory block characteristics, intraoperative hemodynamic stability, postoperative analgesia, recovery profile, and perioperative adverse events. Methods: This prospective, interventional, double-blind, randomized controlled study was conducted in the Department of Anaesthesiology at a tertiary care teaching hospital. Sixty ASA physical status I–II patients scheduled for elective laparoscopic cholecystectomy were randomly allocated into two equal groups. Group L received 1.5 mL of 0.5% isobaric levobupivacaine with fentanyl 25 μg, while Group R received 1.5 mL of 0.75% isobaric ropivacaine with fentanyl 25 μg intrathecally. Sensory block characteristics, intraoperative hemodynamic parameters, adverse events, postoperative analgesia, recovery profile, and patient satisfaction were evaluated. Statistical analysis was performed using SPSS version 26.0, and a p-value <0.05 was considered statistically significant. Results: Baseline demographic and clinical characteristics were comparable between the two groups. Patients receiving levobupivacaine demonstrated a significantly faster onset and longer duration of sensory blockade, resulting in prolonged postoperative analgesia and a significantly longer time to first rescue analgesic requirement. Both groups maintained satisfactory intraoperative hemodynamic stability without significant differences in cardiovascular parameters. Levobupivacaine demonstrated superior sensory block characteristics, prolonged postoperative analgesia, and higher patient satisfaction. Recovery parameters were comparable between the two groups, with no clinically significant differences in postoperative ambulation or spontaneous voiding. Conclusion: Both 0.5% isobaric levobupivacaine and 0.75% isobaric ropivacaine are safe and effective agents for segmental spinal anesthesia during elective laparoscopic cholecystectomy. However, levobupivacaine demonstrated superior overall clinical efficacy by providing faster onset of anesthesia, prolonged sensory blockade, superior postoperative analgesia, higher patient satisfaction, and an excellent safety profile.