“A Comparative Study between Fractionated Dose Versus Bolus Dose Injection of Hyperbaric Levobupivacine in Patients Undergoing Infraumbilical Surgeries Under Subarachnoid Block”

Abstract

Introduction: Spinal anaesthesia is widely employed for infraumbilical surgeries due to its rapid onset, reliable sensory and motor blockade, and favorable postoperative recovery profile. However, sudden sympathetic blockade following intrathecal local anaesthetic administration may result in significant haemodynamic instability. Fractionated dosing of spinal anaesthesia has been proposed as a technique to provide a gradual spread of local anaesthetic, thereby improving cardiovascular stability. Levobupivacaine, a safer S-enantiomer of bupivacaine, offers effective spinal anaesthesia with reduced cardiotoxicity. This study was undertaken to compare the clinical effects of fractionated versus bolus dosing of hyperbaric levobupivacaine in infraumbilical surgeries.

Aim :Comparison of fractionated dose of hyperbaric levobupivacaine versus bolus dose of levobupivacaine in infraumbilical surgeries

Materials and Methods This prospective, comparative study was conducted on 100 adult patients (ASA I–II) undergoing elective infraumbilical surgeries under subarachnoid block. Patients were randomly allocated into two groups: Group F received hyperbaric levobupivacaine in a fractionated manner, while Group B received the same dose as a single bolus. Sensory and motor block characteristics, haemodynamic parameters, and duration of postoperative analgesia were assessed and statistically analyzed.

Results Fractionated dosing demonstrated significantly better haemodynamic stability with fewer episodes of hypotension and reduced vasopressor requirement compared to bolus dosing. Although the onset of sensory and motor blockade was slower in the fractionated group, the duration of sensory block, motor block, and postoperative analgesia was significantly prolonged. Bolus dosing produced faster onset but was associated with greater cardiovascular fluctuations.

Conclusion: Fractionated intrathecal administration of hyperbaric levobupivacaine provides superior haemodynamic stability and prolonged analgesia compared to bolus dosing, making it a safer and more effective technique for infraumbilical surgeries.