IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 1 Ver. I (Jan. 2018), PP 01-04 www.iosrjournals.org DOI: 10.9790/0853-1701010104 www.iosrjournals.org 1 | Page Laparoscopic Cholecystectomy Under Low Thoracic Combined Spinal Epidural Anaesthesia: A Comparative Study Between Isobaric And Hyperbaric Bupivacaine *Loveleen Kour 1 ,Kuldip C.Gupta 2 ,Nandita Mehta 2, Kuldeep Singh Mehta 3 1 MD,Senior resident, Department of Anaesthesia and Intensive Care GMC Jammu, india. 2 Department of Anaesthesia and Intensive Care ASCOMS Sidhra, Jammu, india. 3 Department of Surgery ASCOMS Sidhra Jammu, india. *Corresponding author: Loveleen Kour Abstract Background: Thoracic spinal anaesthesia has proven its efficacy over general anaesthesia as a routine anaesthetic technique for laparoscopic surgeries. This study aimed to compare the block characteristics of isobaric and hyperbaric bupivacaine in thoracic spinal epidural anaesthesia for laparoscopic cholecystectomies. Materials and methods: The study included 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy, divided randomly into two equal groups. Both the groups were given thoracic combined spinal epidural anaesthesia (CSE) at the T9-T10 / T10-T11 interspace using 1.5 ml of isobaric bupivacaine 0.5% (5 mg/ml) + 25μg (0.5 ml) of fentanyl in group I and 1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25μg (0.5 ml) of fentanyl in group H. Results: The onset of analgesia was comparable in both the groups. In contrast to the longer time taken to reach T4(7.8 min) by hyperbaric bupivacaine which also showed longer motor(220min) than sensory block(117min); isobaric bupivacaine showed lesser time to reach T4(2min) and a shorter duration of motor block (90 min) than the sensory block(160min). Conclusion: By providing a sensory block of longer duration than the motor block isobaric bupivacaine is reflected in a better indication for upper abdominal laparoscopic surgeries. Keywords: Baricity, hyperbaric bupivacaine, isobaric bupivacaine,laparoscopic cholecystectomy, thoracic combined spinal epidural anaesthesia. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 18-12-2017 Date of acceptance: 06-01-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Thoracic spinal anaesthesia has come a long way since its introduction by Jonnesco in 1909. Initially used in patients with severe lung disease who could not tolerate general anaesthesia [1]. It was eventually demonstrated to be an effective anaesthetic technique in healthy patients for laparoscopic cholecystectomies with significant post operative benefits [2]. Studies have shown thoracic spinal anaesthesia to provide satisfactory operating conditions and shorter latency of the block with excellent haemodynamic stability for laparoscopic cholecystectomies. Many studies in the past have compared solutions of different baricities in lumbar spinal anaesthesia [3,4] but very few such studies are present for thoracic spinal anaesthesia. Also thoracic subarachnoid space is anatomically different from lumbar thecal space as shown by Hogan QH et al [5]. Hence the aim of this study was to compare the quality of anaesthesia as well as the sensory and motor block characteristics during thoracic combined spinal epidural anaesthesia of a patient group undergoing laparoscopic cholecystectomy with isobaric bupivacaine to those of another patient group treated with hyperbaric bupivacaine. II. Materials and methods After obtaining approval from the institutional ethics committee written consent was obtained from all 60 patients scheduled for elective laparoscopic cholecystectomy. Inclusion criteria were ASA 1and 2 patients aged between 18-65 years with normal coagulation status. Patients belonging to ASA status 3 and 4, acute cholecystitis, acute pancreatitis, severe cardiovascular/renal disability and BMI >30 kg/m 2 were excluded from the study. They were divided randomly by computer generated numbers into two equal groups. Patients were kept fasting six hours prior to surgery and premedicated with tablet alprax 0.25 mg, pantoprazole 40 mg and domperidone 10 mg on the night prior to surgery. Patients were informed about CSE in detail and assured that