Abstract / Summary
Background: General anesthesia (GA) remains the standard technique for laparoscopic cholecystectomy (LC), but it is associated with post-operative nausea and vomiting, airway manipulation, opioid use, and delayed recovery. Segmental thoracic spinal anesthesia (STSA) offers a promising regional alternative; however, intraoperative shoulder pain is a major limitation of neuraxial anesthesia during laparoscopy. We describe a sequential hypobaric–isobaric levobupivacaine technique administered through a single thoracic spinal puncture to optimize segmental sensory blockade and minimize referred shoulder pain. Aims and Objectives: The aim of the study was to evaluate the feasibility, safety, and early clinical outcomes of sequential hypobaric–isobaric levobupivacaine STSA performed via a single T8–T9 puncture in patients undergoing elective LC. Materials and Methods: This prospective observational case series included 15 consecutive adults undergoing LC under STSA at ERA Medical College, Lucknow. A subarachnoid block was performed at T8–T9 using a 25-gauge Quincke needle. Hypobaric levobupivacaine 0.1% (1 mg) was injected first, followed by isobaric levobupivacaine 0.5% (10 mg in 2 mL). Patients were maintained in a 5° reverse Trendelenburg position. Intraoperative hemodynamics, block characteristics, surgical conditions, complications, recovery, and neurological outcomes were assessed. Results: All procedures were completed successfully under STSA without conversion to GA or open surgery. Mean operative duration was 47.5±8.7 min, and mean anesthesia duration was 185.4±22.8 min. Adequate sensory blockade with minimal motor involvement was achieved. No patient experienced shoulder pain, nausea, vomiting, respiratory compromise, or neurological deficit. Transient hypotension occurred in five patients, managed with mephentermine. Conclusion: Sequential hypobaric–isobaric levobupivacaine through a single thoracic puncture appears feasible and effective for LC, potentially overcoming shoulder pain – a key limitation of neuraxial anesthesia. Larger trials are warranted.