Comparison of Thoracic Segmental Spinal Anesthesia Using Isobaric Levobupivacaine With Fentanyl Versus Dexmedetomidine in Patients Undergoing Laparoscopic Cholecystectomy

Introduction: Thoracic segmental spinal anesthesia is increasingly used as an alternative to general anesthesia for laparoscopic cholecystectomy because of its potential benefits in providing effective intraoperative anesthesia and improved postoperative recovery. The present study aimed to compare the hemodynamic effects, block characteristics, and postoperative analgesia effects of isobaric levobupivacaine combined with fentanyl versus dexmedetomidine in thoracic segmental spinal anesthesia. Materials and methods: In this prospective comparative study, 60 patients who underwent elective laparoscopic cholecystectomy were divided into two groups of 30 each. Levobupivacaine was administered intrathecally with fentanyl (25 µg) in one group and levobupivacaine and dexmedetomidine (5 µg) in the other. Hemodynamic parameters, duration of analgesia, features of sensory and motor block, and side effects were recorded. The Chi-square/Fisher's exact test and the independent samples t-test were used for statistical analysis. A statistically significant p-value is one that is less than 0.05. Results: Baseline characteristics were comparable between the groups. The onset of sensory block was significantly faster in the fentanyl group (3.46 ± 1.09 min) compared to the dexmedetomidine group (3.96 ± 0.77 min, p = 0.045). However, the duration of sensory block (190.43 ± 8.48 vs. 157.76 ± 16.31 min, p < 0.001) and duration of analgesia (279.43 ± 30.49 vs. 183.03 ± 20.87 min, p < 0.001) were significantly longer in the dexmedetomidine group. Hemodynamic parameters remained stable in both groups, although dexmedetomidine was associated with greater reductions in heart rate and blood pressure during the early intraoperative period. The incidence of adverse effects was comparable, with no cases of postoperative nausea and vomiting observed. Conclusion: Dexmedetomidine demonstrated superior efficacy as an intrathecal adjuvant by significantly prolonging sensory blockade and postoperative analgesia compared to fentanyl, albeit with a modest increase in manageable hemodynamic effects. These findings support its preferential use in laparoscopic cholecystectomy, where prolonged pain relief and stable intraoperative conditions are desired.