A Comparative Study of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Isobaric Levobupivacaine in Segmental Spinal Anaesthesia for Elective Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is commonly performed under general anaesthesia, which may be unsuitable for patients with compromised cardiopulmonary function. Segmental spinal anaesthesia has emerged as a safer, targeted alternative, providing effective analgesia with fewer systemic effects. The addition of intrathecal adjuvants such as fentanyl and dexmedetomidine may enhance the quality and duration of anaesthesia while minimizing side effects.

Aim and Objective: To compare the efficacy and safety of intrathecal dexmedetomidine versus fentanyl as adjuvants to isobaric levobupivacaine in segmental spinal anaesthesia for elective laparoscopic cholecystectomy.

Materials & Methods: This prospective, randomized, single-centre study enrolled 60 ASA I/II patients aged 18–60 years. Patients were allocated into two groups: Group D (n=30) received 5 µg dexmedetomidine, and Group F (n=30) received 25 µg fentanyl, each combined with 1.5–1.8 ml of isobaric levobupivacaine intrathecally. Outcomes measured included sensory and motor block characteristics, duration of analgesia, postoperative analgesic consumption, intraoperative haemodynamics, and incidence of side effects.

Results: Dexmedetomidine significantly prolonged sensory block duration (110 ± 12.2 min vs. 86 ± 15.3 min), extended motor block (441 ± 11 min vs. 135.3 ± 12.2 min), and delayed the time to first rescue analgesia (291.7 ± 28.7 min vs. 158.99 ± 25.96 min). Postoperative analgesic requirements were significantly lower in Group D. Both groups maintained stable haemodynamics, and the incidence of side effects was minimal and statistically insignificant.

Conclusion: Dexmedetomidine is a more effective intrathecal adjuvant than fentanyl for SSA in laparoscopic cholecystectomy, offering longer-lasting analgesia, reduced drug requirements, and improved patient outcomes