Comparative Study of Intra-operative Hemodynamic Changes During Cesarean Section Under Spinal Block by Using Bupivacaine Alone Versus Bupivacaine with Fentanyl

Abstract

Background: Spinal anesthesia is the preferred anesthetic technique for cesarean section due to its rapid onset and favorable maternal and fetal outcomes. However, it is frequently associated with intra-operative hemodynamic instability, particularly hypotension and bradycardia. The use of intrathecal opioids such as fentanyl as an adjuvant to bupivacaine has been proposed to improve anesthetic quality and cardiovascular stability. Bupivacaine is commonly used for spinal anesthesia in cesarean section, but its use alone may result in significant sympathetic blockade leading to hemodynamic disturbances. The addition of fentanyl may enhance analgesia and reduce adverse hemodynamic effects. Comparative evaluation of these two anesthetic regimens is essential to optimize maternal safety during cesarean delivery. Objective: To compare intra-operative hemodynamic changes during cesarean section under spinal anesthesia using bupivacaine alone versus bupivacaine combined with fentanyl. Methodology: This prospective comparative study was conducted at Irfan General Hospital over a period of four months. A total of 222 patients undergoing cesarean section under spinal anesthesia were included and divided into two equal groups. Group A received intrathecal bupivacaine alone, while Group B received intrathecal bupivacaine with fentanyl. Intra-operative heart rate and blood pressure were recorded at baseline and at regular intervals. Data were analyzed using SPSS, and a p-value <0.05 was considered statistically significant. Results: Baseline demographic and hemodynamic parameters were comparable between the two groups. The incidence of hypotension and bradycardia was significantly higher in patients receiving bupivacaine alone. Patients in the bupivacaine–fentanyl group demonstrated better maintenance of systolic blood pressure and heart rate throughout the intra-operative period (p <0.05). Conclusion: The addition of fentanyl to intrathecal bupivacaine provides superior intra-operative hemodynamic stability compared to bupivacaine alone during cesarean section. This combination appears to be a safer and more effective anesthetic option for improving maternal outcomes.