title: Comparison of fractionated dose versus bolus dose injection in spinal anaesthesia for patients undergoing elective caesarean section: A randomised, double-blind study.
abstract: OBJECTIVE
  Spinal anaesthesia (SA) with bolus dose has rapid onset but may precipitate hypotension. When we inject local anaesthetic in fractions with a time gap, it provides a dense block with haemodynamic stability and also prolongs the duration of analgesia. We aimed to compare fractionated dose with bolus dose in SA for haemodynamic stability and duration of analgesia in patients undergoing elective lower segment caesarean section (LSCS).
  
  
  METHODS
  After clearance from the Institutional Ethics Committee, the study was carried out in sixty patients undergoing elective LSCS. Patients were divided into two groups. Group B patients received single bolus SA with injection bupivacaine heavy (0.5%) and Group F patients fractionated dose with two-third of the total dose of injection bupivacaine heavy (0.5%) given initially followed by one-third dose after 90 s. Time of onset and regression of sensory and motor blockage, intraoperative haemodynamics and duration of analgesia were recorded and analysed with Student's unpairedt-test.
  
  
  RESULTS
  All the patients were haemodynamically stable in Group F as compared to Group B. Five patients in Group F and fourteen patients in Group B required vasopressor. Duration of sensory and motor block and duration of analgesia were longer in Group F (273.83 ± 20.62 min) compared to Group B (231.5 ± 31.87 min)P< 0.05.
  
  
  CONCLUSIONS
  Fractionated dose of SA provides greater haemodynamic stability and longer duration of analgesia compared to bolus dose.
authors.affiliation: Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India.
authors.forename: Jigisha Prahaladray
authors.initials: JP
authors.lastname: Badheka
authors.affiliation: Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India.
authors.forename: Vrinda Pravinbhai
authors.initials: VP
authors.lastname: Oza
authors.affiliation: Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Vyas
authors.affiliation: Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India.
authors.forename: Deepika
authors.initials: D
authors.lastname: Baria
authors.affiliation: Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India.
authors.forename: Poonam
authors.initials: P
authors.lastname: Nehra
authors.affiliation: Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India.
authors.forename: Thomas
authors.initials: T
authors.lastname: Babu
keywords: Anaesthesia; dose fractionation; hypotension; spinal