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Evaluate how injection speed of bupivacaine affects block quality and haemodynamic parameters during spinal anaesthesia.

April 4, 2026Open Access

A randomized double-blind study to compare the effect of speed of injection (15 seconds versus 60 seconds) of 0.5% heavy bupivacaine on quality of block and haemodynamic parameters in infraumbilical surgery under Spinal anaesthesia: Impact of injection speed on quality of block and haemodynamic parameters under Spinal anaesthesia

Key Points

Evaluate how injection speed of bupivacaine affects block quality and haemodynamic parameters during spinal anaesthesia.
Conducted a randomized double-blind trial with 60 ASA I-II adult patients.
Divided into two groups: Group A received bupivacaine over 15 seconds, Group B over 60 seconds.
Measured time to achieve T10 sensory block and monitored haemodynamic parameters at various intervals.
Compared incidence of side effects like hypotension and bradycardia between groups.
Group A achieved T10 sensory block faster (1.91 min) compared to Group B (4.23 min).
Group A also had a quicker onset of motor (6.13 min) and sensory block (3.52 min) than Group B (9.19 min and 5.96 min, respectively).
Group B exhibited greater cephalad spread and required less mephentermine to treat hypotension (3.4 mg vs. 9.6 mg).
Group A experienced more frequent early hypotension and bradycardia than Group B.

Abstract

Introduction: Injection speed during spinal anaesthesia may influence cerebrospinal fluid dynamics, potentially affecting block characteristics and haemodynamic outcomes. However, literature on these parameters remains inconclusive. This study was planned to evaluate the impact of intrathecal injection speed (15 seconds vs. 60 seconds) of 3 ml of 0.5% heavy bupivacaine on block quality and haemodynamic parameters in infraumbilical surgeries. Methods: Sixty ASA I-II adult patients undergoing elective infraumbilical surgeries under spinal anaesthesia were randomized into two groups: Group A received bupivacaine over 15 seconds, Group B over 60 seconds. The primary objective was to compare time taken to achieve T10 sensory block. The secondary objectives included evaluating the changes in key haemodynamic parameters-namely heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)-from baseline at defined intraoperative intervals. Additional secondary objectives included comparison of the block height at 5 minutes, the maximum sensory level achieved and the total dose of mephentermine required to treat spinal anaesthesia-induced hypotension. The study also aimed to compare the incidence of side effects or complications, such as hypotension, bradycardia, respiratory depression, or nausea, between the two groups. Results: Group A had a significantly faster time to T10 block (1.91 ± 0.26 min in Group A vs. 4.23 ± 0.61 min in Group B; p 0.001) and faster onset of motor (6.13 ± 1.02 in Group A vs. 9.19 ± 1.86 in Group B) and sensory block (3.52 ± 0.56 in Group A vs. 5.96 ± 0.87 in Group B) with p 0.001. Group B showed higher cephalad spread at 5 minutes post-injection (T4 in 63.33% in Group B vs. 13.33% in Group A) and lower mephentermine requirement (3.4 ± 4.9 mg in Group B vs. 9.6 ± 5.8 mg in Group A; p 0.001). Early hypotension and bradycardia were more frequent in Group A. Conclusion: Rapid intrathecal injection leads to faster onset but greater haemodynamic instability. Slower injection offers more predictable spread and better haemodynamic stability. Standardizing injection speed may improve anaesthesia safety.

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