LAPAROSCOPIC CHOLECYSTECTOMY UNDER SPINAL ANAESTHESIA- A PROSPECTIVE, RANDOMIZED COMPARATIVE STUDY BETWEEN INTRATHECAL FENTANYL AND CLONIDINE AS ADJUVANT WITH 0.5% HYPERBARIC BUPIVACAINE

BACKGROUND Laparoscopic cholecystectomy is usually done under general anaesthesia but in recent times, several studies have suggested that laparoscopic surgeries are safely done under spinal anaesthesia. To improve the quality of spinal anaesthesia and post-operative analgesia, clonidine and fentanyl have been added with hyperbaric bupivacaine. MATERIALS AND METHODS After obtaining permission from institutional ethical committee, a prospective, randomised study was conducted at a tertiary level hospital (Medical College) for a period of 3 years. Initially 300 patients were included in the study and they were randomly divided into three groups each comprising of 100 patients. In Group A patients, general anaesthesia was administered, group B received spinal anaesthesia with 3.5 ml of 0.5% hyperbaric bupivacaine with fentanyl 25 mcg and patients belonging to group C received spinal anaesthesia with 3.5 ml of 0.5% hyperbaric bupivacaine with 30 mcg of clonidine. Intra operative hypotension, bradycardia, shoulder tip pain and abdominal discomfort/pain were recorded. Post-operative vitals, analgesia and complications were also compared among the groups. RESULTS Incidence of hypotension, bradycardia and abdominal discomfort was significantly higher in group C compared to group B (p<0.05). Abdominal pain started significantly earlier in group A patients compared to other groups. Post-operative pain was better controlled in group C compared to other groups. CONCLUSION Intrathecal fentanyl as adjuvant to bupivacaine is a better choice as it significantly reduces intra operative abdominal discomfort. Though duration of post-operative analgesia is more with clonidine compared to fentanyl, it has higher incidence of hypotension and bradycardia.