Background: Multiple trials have been tried to prevent hypotension during spinal anesthesia.
However, the drug choice and mode of administration is still a matter of debate.
Objectives: To compare the outcome of spinal injection of hyperbaric bupivacaine and fentanyl
separately to standard injection of mixed fentanyl with hyperbaric bupivacaine.
Settings and Design: A randomized, controlled clinical trial.
Patients and Methods: One hundred twenty‑four parturient scheduled for elective cesarean section
were randomly allocated into two groups, each 62 parturient: Group M received spinal anesthesia
using 10 mg bupivacaine 0.5% premixed with 25 μg fentanyl in the same syringe and Group S received
25 μg fentanyl in one syringe and 10 mg bupivacaine 0.5% without barbotage in a second syringe.
Results: Patients with intraoperative pain that was controllable without the need for a shift to
general anesthesia was significantly lower in Group S (3.2%) than in Group M (16.1%). The frequency
of hypotension was significantly lower in Group S compared to Group M (P < 0.05). Time till the onset
of sensory block was nonsignificantly shorter with nonsignificantly higher mean level of maximal
sensory block in Group S compared to Group M (P > 0.05). There was no significant difference in the
time till occurrence of hypotension, duration of hypotension, mean dose of ephedrine used for the
treatment of hypotension and frequency of patients developed itching between the groups (P > 0.05).
Conclusion: Separate intrathecal injection of fentanyl and hyperbaric bupivacaine provided a
significant improvement in the quality of sensory block and significant reduction of the frequency
of hypotension compared to injection of mixed medications.