COMPARISON OF HYPERBARIC BUPIVACAINE AND FENTANYL MIXTURE AND HYPERBARIC BUPIVACAINE ALONE ON BLOOD PRESSURE AND HEART RATE AMONG PATIENTS UNDERGOING UNILATERAL SPINAL BLOCK FOR LOWER LIMB SURGERIES

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Background: Unilateral spinal anesthesia is widely utilized in lower limb surgeries due to its ability to provide effective anesthesia with reduced hemodynamic instability. Combining hyperbaric bupivacaine with fentanyl has been proposed to enhance anesthetic efficacy while reducing adverse effects such as hypotension and bradycardia. Despite its documented benefits, limited research has explored the impact of this combination in the Pakistani population, where unique demographic and physiological characteristics may influence clinical outcomes. Objective: To compare the effects of hyperbaric bupivacaine combined with fentanyl versus hyperbaric bupivacaine alone on blood pressure and heart rate in patients undergoing unilateral spinal block for lower limb surgeries. Methods: This randomized controlled trial was conducted over six months at Northwest General Hospital, Peshawar, and included 60 patients aged 20–60 years undergoing unilateral lower limb surgery. Patients were randomly divided into two groups: Group A received 7.25 mg of hyperbaric bupivacaine combined with 25 µg fentanyl, while Group B received 10 mg of hyperbaric bupivacaine alone. Blood pressure and heart rate were closely monitored pre- and post-anesthesia. Hypotension, defined as a systolic blood pressure drop of more than 20% from baseline, was treated with ephedrine or phenylephrine, while bradycardia, defined as a heart rate below 50 beats per minute, was managed with atropine. Results: Group A demonstrated significantly fewer episodes of hypotension (12%) compared to Group B (28%) and a lower incidence of bradycardia (4% vs. 10%). Group A also exhibited improved hemodynamic stability and faster recovery. No significant adverse events were reported in either group. Conclusion: The combination of fentanyl and hyperbaric bupivacaine improves hemodynamic stability and reduces the risk of hypotension and bradycardia in unilateral spinal anesthesia for lower limb surgeries, offering a safer and more effective anesthetic option.