Authors: Chandra R et al.
Chandra R, Khan I, Paliwal N W, et al.
Source: Cureus. 17(11): e97048. doi:10.7759/cureus.97048.
Summary:
This randomized controlled trial examined whether using a combination of hypobaric plus isobaric bupivacaine in thoracic segmental spinal anesthesia (TSSA) reduces intraoperative shoulder pain during laparoscopic cholecystectomy compared with isobaric bupivacaine alone. Ninety ASA I–II patients underwent elective cholecystectomy under TSSA, receiving identical total bupivacaine dosing (11 mg) and dexmedetomidine (5 μg). Group 1 received only isobaric bupivacaine, while Group 2 received a hypobaric–isobaric mixture. All cases were completed under spinal anesthesia without conversion to general anesthesia. Hemodynamics remained stable and similar between groups. Shoulder-tip pain occurred in 13.3% of patients in the isobaric-only group versus 2.2% in the hypobaric–isobaric group. Patient and surgeon satisfaction were significantly higher with the combination technique. The number-needed-to-treat was nine, indicating a clinically meaningful reduction in shoulder discomfort.
What You Should Know:
• Thoracic segmental spinal anesthesia can be safely used for laparoscopic cholecystectomy with low local anesthetic doses.
• Adding hypobaric bupivacaine to isobaric bupivacaine markedly reduces intraoperative shoulder-tip pain.
• Hemodynamic stability was preserved in both groups with minimal hypotension.
• No patient required conversion to general anesthesia.
• Satisfaction scores were significantly better with the hypobaric–isobaric technique.
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