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International Journal of Clinical Trials| January-March2020| Vol 7| Issue 1Page 28International Journal of Clinical TrialsKatoch ML et al. Int J Clin Trials. 2020Feb;7(1):28-31http://www.ijclinicaltrials.compISSN2349-3240| eISSN 2349-3259Original ResearchArticleComparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomyMadan Lal Katoch, Loveleen Kour*INTRODUCTIONPain has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Unrelieved postoperative pain may result in clinical and psychological changes that increase morbidity and decrease the quality of life.1Besides the distress caused, severe postoperative pain increases the work of breathing as it limits full chest expansion and impairs patient’s ability to cough effectively.2Many interventions have been tried to reduce such severe pain; including epidural analgesia, patient controlled analgesia, transversus abdominis plane block and local wound infiltration.Laparoscopic cholecystectomy is commonly performed procedure for treating symptomatic gallstones. The benefits of laparoscopic surgery include reduced haemmorhage, smaller and more cosmetic incision and shorter hospital stay. Pain after laparoscopy results from ABSTRACT
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Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies. Incorporation of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019. They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B. The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block. There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.