Comparison of Fractionated Dose Versus Bolus Dose of Hyperbaric Bupivacaine Injection in Spinal Anesthesia

Mishra S, Dubey N, Verma A, et al.

Cureus. 2025;17(7):e88714. doi:10.7759/cureus.88714

This randomized controlled study compared the hemodynamic effects of fractionated versus bolus dosing of hyperbaric bupivacaine for spinal anesthesia in 60 elderly patients undergoing lower limb surgery. Group B received a single bolus dose, while Group F received the same total volume in two stages. The primary outcome was mean arterial pressure (MAP) over time; secondary outcomes included incidence of hypotension, bradycardia, and vasopressor use.

While overall trends were similar between groups, MAP and diastolic blood pressure at the 90-minute mark were significantly higher in the fractionated group, suggesting better stability. Additionally, Group F required fewer vasopressors—12 patients (40%) compared to 23 patients (76%) in the bolus group, a statistically significant difference.

The study concludes that fractionated dosing may offer improved hemodynamic control and reduced need for vasopressors in elderly patients, though larger trials are needed to validate these findings and guide routine clinical use.

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