Comparison of efficacy of Interathecal 0.5% Isobaric Levobupivacaine With Fentanyl Versus 0.5% Isobaric Bupivacaine with Fentanyl for Inguinal Hernia Repair

Introduction: As practice of medicine focuses increasinglyon outpatient care, spinal anaesthetics should provide shortacting and adequate anaesthesia without compromising earlyambulation and discharge from day care surgery unit. Bothclinical and preclinical trials have demonstrated a bettersafety profile for Levobupivacaine than for Bupivacaine. Inthis study we proposed to compare a combination of low doseLevobupivacaine with Fentanyl to low dose isobaric racemicBupivacaine with Fentanyl for the characteristics of spinalblockade with respect to onset and duration.Material and Methods: The present study was conductedamong 70 patients who were classified as American Society ofAnaesthesiologists (ASA) physical status I or II, undergoingelective inguinal hernia repair surgeries under spinalanaesthesia divided into two groups of 35 each. Patients inGroup LB were given Levobupivacaine 0.5% isobaric 5 mg(1ml) + Inj. Fentanyl 25 µg (0.5ml) and Group B were givenBupivacaine 0.5% isobaric 5 mg (1ml) + Inj. Fentanyl 25 µg(0.5ml). The onset of motor blockade (Time taken for motorblockade to reach Modified Bromage Scale 1) and duration ofmotor blockade (Regression of motor blockade to ModifiedBromage scale 0) were noted. Sensory and motor blocks wereassessed at the start of surgery and at the end of surgery forcomparison between groups.Results: Intrathecal 0.5% isobaric Levobupivacaine withFentanyl combination has slower onset of sensory blockadeand motor blockade, slower time for achieving peak sensorylevels when compared to 0.5% isobaric bupivacaine withFentanyl combination. But, intrathecal 0.5% isobaricLevobupivacaine has a faster onset of two segment regression,faster S2 regression and faster regression of motor blockwhen compared to 0.5% isobaric bupivacaine with Fentanylcombination. Similarly, the time to ambulation and timeto urination are also early with intrathecal 0.5% isobaricLevobupivacaine.Conclusion: Intrathecal 0.5% isobaric Levobupivacaineoffers an advantage for the patient for faster discharge hencecan be suitable for day care surgeries.

Intramedullary cysticercosis.

A 42-year-old soldier, a known case of cerebral parenchymal neurocysticercosis presented with insidious onset gradually progressive weakness of both lower limbs for six months. Investigations revealed an intramedullary cyst in the cervicodorsal region. Following surgical excision of an intramedullary cysticercus cyst, the patient showed recovery in his neurological deficits.