Spinal Anaesthesia for Urological Surgery: A Comparison of Isobaric Solutions of Levobupivacaine and Ropivacaine with Dexmedetomidine.

BACKGROUND: Subarachnoid block is used in most of urological surgeries and finding the best possible drug has always been a challenge. Bupivacaine's pure enantiomers ropivacaine and levobupivacaine have lesser systemic toxicity. Isobaric solution has extra benefit of not affecting the intrathecal dispersion of drug. Dexmedetomidine when added intrathecally provides longer duration of analgesia and anaesthesia. Aim of this study is to compare onset, duration of the block with both the drugs along with their hemostability and postoperative analgesia.

METHODS: It is a Prospective Randomized Double-Blind Study. It includes 68 patients undergoing urological procedures under subarachnoid block. Group LD: Patients will receive 3.5 ml of Isobaric Levobupivacaine 0.5% + Dexmedetomidine 10 µg (0.1ml) Group RD: will receive 3.5ml of Isobaric Ropivacaine 0.5% + Dexmedetomidine 10 µg (0.1ml).

RESULTS: Time taken for onset of sensory and motor block is significantly more in ropivacaine while duration of block is more in levobupivacaine.

CONCLUSIONS: Addition of Dexmedetomidine to Isobaric Levobupivacaine significantly prolongs the duration of analgesia and anaesthesia compared to Ropivacaine and maintains stable hemodynamics. Ropivacaine is a suitable drug for day care whilst levobupivacaine is an excellent agent for longer surgeries. Dexmedetomidine is an effective non-opioid adjuvant which improves effectiveness of block without increasing the risk of side effects.