Objective: To assess feasibility, safety, and efficacy of segmental spinal anesthesia with isobaric levobupivacaine in patients undergoing various abdominal and lower limb surgeries.
Methods: This was a prospective cohort study conducted at the Department of Anesthesiology and Critical Care of Kota Heart Institute and group of hospitals in India. The study involved 100 patients undergoing various abdominal and lower limb surgeries under segmental spinal anesthesia (SSA). Isobaric levobupivacaine 0.5% with fentanyl 20-25 μg or dexmedetomidine 5-10 as adjuvant or hypobaric levobupivacaine 0.167% was injected in intervertebral space depending on the surgery. Hemodynamic parameters, postoperative pain level, and adverse effects were analyzed with a p-value less than 0.05 was considered statistically significant.
Results: An overall male predominance was observed with a 1:0.515 male-to-female ratio. The most affected age group was 41-50 years (37%), with a mean age of 44.51 ± 11.72 years. ASA classification indicated 34% of patients in ASA I, 40% in ASA II, 24% ASA III and 2% in ASA IV . The primary surgery was laparoscopic cholecystectomy (26%) in normal risk group and orthopedic in high-risk group(20%). Postoperative pain assessment showed mean VAS scores ranging from 1.92 to 3.42 at different time intervals. Common adverse effects were hemodynamic instability (13%), shoulder tip pain (33%), PONV (3%), headache (6%), pruritis (2%) and urinary retention (1%). The hemodynamic instability showed less incidence in ASA III/IV category.
Conclusion: Segmental spinal anesthesia can be used successfully for abdominal and lower limb orthopedic surgeries in patients of ASA I to ASA IV.
Kurdi MS, Agrawal P, Thakkar P, Arora D, Barde SM, Eswaran K. Recent advancements in regional anaesthesia. Indian J Anaesth. 2023;67(1):63–70. doi:10.4103/ija.ija_1021_22
Nandanwar AS, Patil Y, Wagaskar VG, Baheti VH, Tanwar HV, Patwardhan SK. A Comparison of efficacy of segmental epidural block versus spinal anaesthesia for percutaneous nephrolithotomy. J Clin Diagn Res. 2015;9(8):UC01–4. doi:10.7860/JCDR/2015/14091.6301
Paul A, Borkar A. Anaesthetic management for mastectomy in a male with unilateral gynecomastia: the utilization of thoracic segmental spinal anaesthesia and erector spinae plane block. Cureus. 2023;15(10):e47502. doi:10.7759/cureus.47502
Aljuba YM Sr, Amro AM, Alkadi AT, Taamrah H, Hamamdh MG. Thoracic segmental spinal anesthesia for emergency cholecystectomy: a case report. Cureus. 2022;14(10):e30184. doi:10.7759/cureus.30184
Kejriwal AK, Begum S, Krishan G, Agrawal R. Laparoscopic cholecystectomy under segmental thoracic spinal anesthesia: a feasible economical alternative. Anesth Essays Res. 2017;11(3):781–3. doi:10.4103/0259-1162.174467
Zhang N, He L, Ni JX. Level of sensory block after spinal anesthesia as a predictor of hypotension in parturient. Medicine (Baltimore). 2017;96(25):e7184. doi:10.1097/MD.0000000000007184
le Roux JJ, Wakabayashi K, Jooma Z. Defining the role of thoracic spinal anaesthesia in the 21st century: a narrative review. Br J Anaesth. 2023;130(1):e56–65. doi:10.1016/j.bja.2022.03.008
Das W, Bhattacharya S, Ghosh S, Saha S, Mallik S, Pal S. Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial. Saudi J Anaesth. 2015;9(2):184–8. doi:10.4103/1658-354X.152881
Heppolette CAA, Brunnen D, Bampoe S, Odor PM. Clinical pharmacokinetics and pharmacodynamics of levobupivacaine. clin pharmacokinet. 2020;59(6):715–45. doi: 10.1007/s40262-020-00868-0
Vergari A, Frassanito L, Nestorini R, Caputo CT, Chierichini A, DI Stasio E, et al. Hypobaric versus isobaric spinal levobupivacaine for total hip arthroplasty. Minerva Anestesiol. 2017;83(4):361–8. doi:10.23736/S0375-9393.16.11506-8
Pillai A, Monteiro RS, Choi SW, Yentis SM, Bogod D. Strength of commonly used spinal needles: the ability to deform and resist deformation. Anaesthesia. 2017;72(9):1125–33. doi:10.1111/anae.13959
Uppal V, Retter S, Shanthanna H, Prabhakar C, McKeen DM. Hyperbaric versus isobaric bupivacaine for spinal anesthesia: systematic review and meta-analysis for adult patients undergoing noncesarean delivery surgery. Anesth Analg. 2017;125(5):1627–37. doi:10.1213/ANE.0000000000002254
Manasra MR, Heih OQ, Adwan RF, Maraqa MA. The use of thoracic segmental spinal anaesthesia for thoracoscopic diaphragmatic hernia repair in an adult with cardiac compromise. Cureus. 2024;16(3):e56029. doi:10.7759/cureus.56029
Singhal G, Mathur B L, Mathur AK. Efficacy and safety of segmental spinal anaesthesia in laparoscopic cholecystectomy: A prospective study. Indian J Clin Anaesth 2023;10(1):3–10. https://doi.org/10.18231/j.ijca.2023.002
Kejriwal AK, Begum S, Krishan G, Agrawal R. Laparoscopic cholecystectomy under segmental thoracic spinal anesthesia: a feasible economical alternative. Anesth Essays Res. 2017;11(3):781–3. doi:10.4103/0259-1162.174467
Wang AY, Liu P, Balonov K, Riesenburger R, Kryzanski J. Use of spinal anesthesia in lower thoracic spine surgery: a case series. Oper Neurosurg (Hagerstown). 2022;23(4):298-303. doi:10.1227/ons.0000000000000325
Vincenzi P, Stronati M, Garelli P, Gaudenzi D, Boccoli G, Starnari R. Segmental thoracic spinal anesthesia for laparoscopic cholecystectomy with the “hypobaric” technique: a case series. Local Reg Anesth. 2023;16:31–40. doi:10.2147/LRA.S395376
Paliwal N, Maurya N, Suthar OP, Janweja S. Segmental thoracic spinal anesthesia versus general anesthesia for breast cancer surgery: A prospective randomized-controlled open-label trial. J Anaesthesiol Clin Pharmacol. 2022;38(4):560–5. doi:10.4103/joacp.JOACP_679_20
Haloi P, Biswas R, Bora, A. Thoracic segmental spinal anesthesia for radical nephrectomy in a patient with amyotrophic lateral sclerosis–a case report. Ain-Shams J Anesthesiol 2023;32 (15):1–4. doi:10.1186/s42077-023-00326-6
Chandra R, Misra G, Datta G. Thoracic spinal anesthesia for laparoscopic cholecystectomy: an observational feasibility study. Cureus. 2023;15(3):e36617. doi:10.7759/cureus. 36617
