• Maliha Khalid Khan PAF Hospital Mushaf Sargodha
  • Amran Hafiz PAF Hospital Mushaf Sargodha
  • Faheem Feroze Combind Military Hospital Maliar Karachi
  • Anjum Atique Tahir Armed Forces Institute of Urology Rawalpindi
  • Saeed Farooq Civil Hospital Sargodha
  • Muhammad Shaheer Bin Faheem Karachi Institute of Medical Sciences Karachi



Background: Spinal anaesthesia has its unique place in modern anaesthetic practice. In past, most of the surgeries, irrespective of the site of surgery, were performed in general anaesthesia but now in the modern anaesthetic field, spinal anaesthesia has markedly replaced general anaesthesia, specifically in obstetrics, lower limbs, and abdominal surgeries. Methods: A total of 100 patients fit to undergo lower limb surgery between the ages of 20 to 70 years were included in the study. 50 patients were in 0.5% hyperbaric bupivacaine (Group A) while 50 patients were in the 0.75% hyperbaric bupivacaine group (Group B). Patients with a history of allergies to local anaesthetics, ischemic heart disease and contraindications to spinal anaesthesia were excluded. At the end of the injection, the patient was immediately laid down and tilted to 30 degrees lateral on the operative side for unilateral anaesthesia. Mean arterial pressure at baseline, 15, 30, 45 and 60 minutes was recorded by trainee anaesthesia. A baseline was taken of mean arterial pressure measured 15 minutes before induction of spinal anaesthesia in a lying position. Results: The mean baseline arterial pressure of patients in group A was 88.72±1.71 mmHg and in group B was 88.94±1.95 mmHg. Mean arterial pressure MAP at 15, 30, 45 and 60 minutes in both groups was as follows; 86.22±2.55 vs 81.78±1.52 mmHg, 83.72±3.36 vs 75.84±1.34 mmHg, 80.02±3.40 vs 70.90±0.97 mmHg and 77.14±4.24 vs 66.06±1.62 mmHg respectively (p-value <0.05). Conclusion: This study concluded that the hemodynamic parameters in terms of mean arterial pressure remained more stable by deviating less from the baseline value with the use of a low dose of 0.5% hyperbaric bupivacaine instead of 0.75% hyperbaric bupivacaine in patients undergoing lower limb surgery under unilateral spinal anaesthesia.

Author Biographies

Maliha Khalid Khan, PAF Hospital Mushaf Sargodha


Amran Hafiz, PAF Hospital Mushaf Sargodha


Faheem Feroze, Combind Military Hospital Maliar Karachi


Anjum Atique Tahir, Armed Forces Institute of Urology Rawalpindi


Saeed Farooq, Civil Hospital Sargodha


Muhammad Shaheer Bin Faheem, Karachi Institute of Medical Sciences Karachi



Greene NM. Physiology of spinal anesthesia. Baltimore: Williams and Wilkins, 2001; p.78–108.

Boon JM, Abrahams PH, Meiring JH, Welch T. Lumbar puncture: anatomical review of a clinical skill. Clin Anat Med 2004;17(7):544–53.

Di Cianni S, Rossi M, Casati A, Cocco C, Fanelli G. Spinal anesthesia: an evergreen technique. Acta Biomed 2008;79(1):9–17.

Urmey WF. Spinal anaesthesia for outpatient surgery. Best Pract Res Clin Anaesthesiol 2003;17(3):335–46.

Casati A, Fanelli G. Restricting spinal block to the operative side: why not? Reg Anesth Pain Med 2004;29(1):4–6.

Rani Z, Mehmood T, Ishrat Z. Comparison of Efficacy and Hemodynamic Effects of two Different Concentrations of Hyperbaric Bupivacain 0.5% and 0.75% during Spinal Anesthesia. Pak J Med Health Sci 2019;13(3):659–64.

Rai SA, Malak AM, Ali CA. Comparison between 0.5% And 0.75% hyperbaric bupivacaine given intrathecally in elective caesarean section. J Postgrad Med Inst 2018;32(1):87–90.

Iftikhar H, Aslam A, Rehman HU, Ali Z, Abbass MA, Haider Z. Comparison of Haemodynamic Stability with 0.5% and 0.75% Hyperbaric Bupivacaine During Spinal Anaesthesia in Women Undergoing Caesarean Section. Pak Armed Forces Med J 2021;71(6):2078–81.

Fanelli G, Borghi B, Casati A, Bertini L, Montebugnoli M, Torri G. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Italian Study Group on Unilateral Spinal Anesthesia. Can J Anaesth 2000;47(8):746–51.

Cindea I, Balcan A, Gherghina V, Nicolae G. Unilateral spinal anesthesia versus conventional spinal anesthesia in ambulatory lower abdominal surgery. Eur J Anaesth 2007;24:10.

Khatouf M, Loughnane F, Boini S, Heck M, Meuret P, Macalou D, et al. Rachianesthésie hypobare unilatérale chez le sujet âgé pour la chirurgie traumatique de la hanche: étude pilote [Unilateral spinal anaesthesia in elderly patient for hip trauma: a pilot study]. Ann Fr Anesth Reanim 2005;24(3):249–54.

Esmaoğlu A, Boyaci A, Ersoy O, Güler G, Talo R, Tercan E. Unilateral spinal anaesthesia with hyperbaric bupivacaine. Acta Anaesthesiol Scand 1998;42(9):1083–7.

Casati A, Fanelli G, Beccaria P, Aldegheri G, Berti M, Senatore R, et al. Block distribution and cardiovascular effects of unilateral spinal anaesthesia by 0.5% hyperbaric bupivacaine. A clinical comparison with bilateral spinal block. Minerva Anestesiol 1998;64(7-8):307–12.

Casati A, Fanelli G, Cappelleri G, Borghi B, Cedrati V, Torri G. Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth 1998;45(9):850–4.

Casati A, Fanelli G, Cappelleri G, Aldegheri G, Berti M, Senatore R, et al. Effects of speed of intrathecal injection on unilateral spinal block by 1% hyperbaric bupivacaine. A randomized, double-blind study. Minerva Anestesiol 1999;65(1-2):5–10.

Casati A, Fanelli G, Aldegheri G, Colnaghi E, Casaletti E, Cedrati V, et al. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med 1999;24(3):214–9.

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