Comparative study of two thoracic segmental spinal anaesthesia techniques for laparoscopic cholecystectomy: low-dose hypobaric ropivacaine and isobaric ropivacaine at T10-11 intervertebral space vs. standard technique using isobaric levo bupivacaine at T8-T10 intervertebral space


  • Sachin Nagar Aarvy Superspeciality Hospital, Kalyani Hospital, Aryan hospital, Gurugram, Haryana, India
  • Naresh Paliwal Department of Anaesthesiology, Dr. Panjabrao Deshmukh Medical College, Amravati, Maharashtra, India
  • Robin Lohia Aarvy Superspeciality Hospital, Kalyani Hospital, Aryan hospital, Gurugram, Haryana, India
  • Vivek Saluja Aarvy Superspeciality Hospital, Kalyani Hospital, Aryan hospital, Gurugram, Haryana, India
  • Narender Dutt Aarvy Superspeciality Hospital, Kalyani Hospital, Aryan hospital, Gurugram, Haryana, India



Segmental spinal anaesthiaesia, Levo-Bupivacaine, Ropivacaine, Shoulder Tip Pain, Haemodynamic stability


Background: Many prior studies have utilized thoracic or lumbar spinal anesthesia with isobaric/hyperbaric bupivacaine or Ropivacaine and opioids for laparoscopic cholecystectomy and have reported variable results. our study is centered around addressing the occurrence of intraoperative right shoulder pain and its potential impact on the need for conversion to general anesthesia.

Methods: This is a prospective comparative case series study in which 70 patients scheduled for elective laparoscopic cholecystectomy were. Patients in Group R received 1 ml (1 mg) of Hypobaric Ropivacaine 0.1% at T10-11 followed by 25 mcg fentanyl, and 5 mg Isobaric Ropivacaine 0.5% whereas patients in Group B received 1.5 ml (7.5 mg) Isobaric levo Bupivacaine 0.5% and 25 mcg fentanyl at T8-T10. Patients in both the groups were compared for incidence of shoulder tip pain and Hemodynamic stability.

Results: Both techniques achieved satisfactory anaesthesia quality, with similar results in surgical anaesthesia onset. Average surgical duration was 45-75 minutes with average of 60 mins with longer durations in two cases common to both the groups. In group R there was there was no bradycardia or hypotension recorded more than 10% of preinduction vitals. Whereas in group B 2 patients had bradycardia and hypotension more than 10% of preinduction vitals.

Conclusions: The T10-11 technique using low-dose (6 mg) hypobaric ropivacaine and isobaric Ropivacaine appears to be superior in terms of shoulder tip pain, and hemodynamic stability compared to the T8-T10 technique using isobaric levo-Bupivacaine alone in higher dose.


Shatri G, Singh A. Thoracic Segmental Spinal Anesthesia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

Aljuba YM Sr, Amro AM, Alkadi AT, Taamrah H, Hamamdh MG. Thoracic Segmental Spinal Anesthesia for Emergency Cholecystectomy: A Case Report. Cureus. 2022;14(10):e30184.

Mehta N, Dar MR, Sharma S, Mehta KS. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy: A feasibility study. J Anaesthesiol Clin Pharmacol. 2016;32(2):224-8.

Nganga NW. Spinal anaesthesia: advantages and disadvantages. East Afr Med J. 2010;87(6):225-6.

Vincenzi P, Stronati M, Garelli P, Gaudenzi D, Boccoli G, Starnari R. Segmental Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy with the "Hypobaric" Technique: A Case Series. Local Reg Anesth. 2023;16:31-40.

Kejriwal A, Begum S, Krishan G, Agrawal R. Laparoscopic cholecystectomy under segmental thoracic spinal anesthesia: a feasible economical alternative. Anesth Essays Res. 2017;11(3):781.

Imbelloni LE. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique. Saudi J Anaesth. 2014;8(4):477-83.

Zorko N, Kamenik M, Starc V. The effect of Trendelenburg position, lactated Ringer's solution and 6% hydroxyethyl starch solution on cardiac output after spinal anesthesia. Anesth Analg. 2009;108(2): 655-9.

Graf BM, Abraham I, Eberbach N, Kunst G, Stowe DF, Martin E. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties. Anesthesiology. 2002;96(6):1427-34.

Bajwa SJ, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol. 2013;29(4):530-9.

Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A. 2009;19(3):323-7.

Tiwari S, Chauhan A, Chaterjee P, Alam MT. Laparoscopic cholecystectomy under spinal anaesthesia: A prospective, randomised study. J Minim Access Surg. 2013;9(2):65-71.

Chen W, Wu Q, Fu N, Yang Z, Hao J. Patient selection for ambulatory laparoscopic cholecystectomy: A systematic review. J Minim Access Surg. 2022;18(2):176-80.

Kour L, Katoch ML. Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies. Int J Res Med Sci. 2019;7(12):4568-72.

Kaur A, Singh RB, Tripathi RK, Choubey S. Comparision between bupivacaine and ropivacaine in patients undergoing forearm surgeries under axillary brachial plexus block: a prospective randomized study. J Clin Diagn Res. 2015;9(1):UC01-6.

Malinovsky JM, Charles F, Kick O, et al. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg. 2000;91(6):1457-60.

Jaafarpour M, Vasigh A, Najafi F, Sayadi H, Shafiei E. A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis. Anesth Pain Med. 2023;13(3):e134732.

Olapour A, Akhondzadeh R, Rashidi M, Gousheh M, Homayoon R. Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia. Anesth Pain Med. 2020;10(1):e94155.

Bhat SN, Himaldev, Upadya M. Comparison of efficacy and safety of ropivacaine with bupivacaine for intrathecal anesthesia for lower abdominal and lower limb surgeries. Anesth Essays Res. 2013; 7(3):381-5.

Weiniger CF, Heesen M, Knigin D, Deutsch F, Hilber N, Avidan A. Association Between hyperbaric bupivacaine dose and maternal hypotension: retrospective database study of 8226 women undergoing cesarean delivery under spinal anesthesia. Anesth Analg. 2021;133(4):967-75.






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