title: Two syringe spinal anesthesia technique for cesarean section: A controlled randomized study of a simple way to achieve more satisfactory block and less hypotension.
abstract: 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.
  
  
  OBJECTIVE
  To compare the outcome of spinal injection of hyperbaric bupivacaine and fentanyl separately to standard injection of mixed fentanyl with hyperbaric bupivacaine.
  
  
  METHODS
  A randomized, controlled clinical trial.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia and Intensive Care, Faculty of Medicine, Benha University, Benha, Egypt.
authors.forename: Amr Aly Ismail
authors.initials: AA
authors.lastname: Keera
authors.affiliation: Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Ali Mohamed Ali
authors.initials: AM
authors.lastname: Elnabtity
keywords: Bupivacaine; cesarean section; fentanyl; separate; spinal anesthesia