Comparison of efficacy and safety of isobaric levobupivacaine with hyperbaric bupivacaine for exploratory appendicectomy under subarachnoid block with dexmedetomidine as sedative agent-An observational study.

Abstract

BACKGROUND: Appendicectomy in past was performed under general anaesthesia, in recent years there has been growing emphasis on the role of regional anaesthesia especially spinal anaesthesia. Bupivacaine is available in isobaric and hyperbaric forms for intrathecal use and opioids are used as additives to modify their effects. OBJECTIVE(S): To compare: The efficacy, onset, duration, haemodynamics parameters and side effects of intrathecal levobupivacaine plus fentanyl vs hyperbaric bupivacaine plus fentanyl as anaesthetic and analgesic agents and asses level of sedation. STUDY DESIGN: An Observational Study. PARTICIPANTS: 100 adult patients aged 18 to 45 years, of either sex, ASA- IE &IIE undergoing emergency exploratory appendicectomy under spinal anesthesia. METHODS: Patients were divided into two groups. Group I received spinal anaesthesia with 3ml of 0.5% isobaric levobupivacaine with 20µg fentanyl and group II with 3ml of 0.5% hyperbaric bupivacaine with 20µg fentanyl and i.v dexmedetomidine started in both groups. Quality of anaesthesia, sensory and motor blockade characteristics, haemodynamic parameters, sedaion score, duration of analgesia and side effects were compared. RESULTS: The quality of anaesthesia was comparable in both the groups. The mean onset of sensory and motor block was faster and duration was significantly prolonged in groupII. Time to first supplemental analgesia was longer in group II. Haemodynamic stability was better in group I and side effects were comparable. CONCLUSIONS: Both isobaric levobupivacaine and hyperbaric bupivacaine provides adequate spinal block. Levobupivacaine enables quicker recovery and better haemodynamic stability as compared with hyperbaric bupivacaine, while hyperbaric bupivacaine is better for prolonged surgeries. IMPLICATIONS Levobupivacaine better alternative in appendicectomy.