{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T04:34:40Z","timestamp":1783226080211,"version":"3.54.6"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007941","name":"Addis Ababa University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007941","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Spinal anesthesia with bupivacaine has side effects such as hypotension, respiratory depression, vomiting, and shivering. The side effects are dose-dependent, therefore different approaches have been attempted to avoid spinal-induced complications including lowering the dose of local anesthetic and mixing it with additives like Neuraxial opioids.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To compare the Hemodynamic and analgesic effects of intrathecal fentanyl as an adjuvant with low and conventional doses of bupivacaine in patients undergoing elective cesarean section under spinal anesthesia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>An institutional-based prospective cohort study was conducted on 90 patients. Data was collected with chart review, intraoperative observation, and postoperatively patient interview. Data was entered into EPI INFO and transport to SPSS version 23 for analysis of variables using one-way ANOVA, Kruskal Wallis H rank test, and chi-square.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Result<\/jats:title>\n<jats:p>Hypotension but not bradycardia, was significantly frequent in a conventional dose of bupivacaine alone (CB) group and a conventional dose of bupivacaine with fentanyl (CBF) groups than that of the lower dose of bupivacaine with fentanyl (LBF) groups. Duration of analgesia was significantly longer in LBF (248\u00b1 35.6 minutes) and in CBF groups (260.3\u00b140.3 minutes) than in CB group (167.10 \u00b1 31.45 minutes). Time for the first analgesic request was significantly later in LBF (304\u00b147.8 minutes) and CBF (294.6\u00b199.5 minutes) groups than that in CB group (177\u00b125.88 minutes).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The Lower dose of bupivacaine is associated with less risk of hypotension and faster recovery. Adding fentanyl with the lower dose of bupivacaine in spinal anesthesia for cesarean section could provide comparable anesthesia with the lower risk of hypotension and longer postoperative analgesia.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0268318","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T17:28:39Z","timestamp":1657214919000},"page":"e0268318","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Hemodynamic and analgesic effect of intrathecal fentanyl with bupivacaine in patients undergoing elective cesarean section; a prospective cohort study"],"prefix":"10.1371","volume":"17","author":[{"given":"Ayub Mohammed","family":"Ebrie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misrak","family":"Woldeyohanis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4194-4724","authenticated-orcid":true,"given":"Bedru Jemal","family":"Abafita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9371-9545","authenticated-orcid":true,"given":"Siraj Ahmed","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abebayehu","family":"Zemedkun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"Yimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zewetir","family":"Ashebir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salih","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"pone.0268318.ref001","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12978-015-0114-8","article-title":"Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: a retrospective record review","volume":"13","author":"F.E. Abebe","year":"2015","journal-title":"Reprod Health"},{"issue":"5","key":"pone.0268318.ref002","doi-asserted-by":"crossref","first-page":"e12738","DOI":"10.5812\/aapm.12738","article-title":"Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section","volume":"7","author":"F Farzi","year":"2017","journal-title":"Anesth Pain Med"},{"key":"pone.0268318.ref003","unstructured":"central statistical agency (CSA) [Ethiopia], Ethiopia demograpic and health survey 2016, Addis Ababa, Ethiopia, and Rockville, Maryland, USA. 2016."},{"key":"pone.0268318.ref004","first-page":"3","volume-title":"Regional Analgesia in Obstetrics","author":"K Susan","year":"2000"},{"issue":"5","key":"pone.0268318.ref005","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1213\/ANE.0b013e3181f2eae1","article-title":"The Dose-Dependent Effects of Phenylephrine for Elective Cesarean Delivery Under Spinal Anesthesia","volume":"111","author":"Adrienne Stewart","year":"2010","journal-title":"Anesthesia & Analgesia"},{"issue":"12","key":"pone.0268318.ref006","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1017\/S0265021505001523","article-title":"Levobupivacaine and fentanyl for spinal anaesthesia: a randomized trial","volume":"22","author":"Y. Y. Lee","year":"2005","journal-title":"European Journal of Anaesthesiology: December"},{"issue":"3","key":"pone.0268318.ref007","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/ACO.0b013e3283530dab","article-title":"Cesarean delivery fluid management","volume":"25","author":"Mercier","year":"2012","journal-title":"Current Opinion in Anaesthesiology"},{"key":"pone.0268318.ref008","first-page":"513628","article-title":"Comparison of postoperative analgesic effect of intrathecal clonidine and fentanyl added to bupivacaine in patients undergoing cesarean section: a prospective randomized double-blind study","volume":"2014","author":"MB Khezri","year":"2014","journal-title":"Pain Res Treat"},{"key":"pone.0268318.ref009","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.aat.2012.03.001","article-title":"Comparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery","volume":"50","author":"MB Khezri","year":"2012","journal-title":"Acta Anaesthesiologica Taiwanica"},{"issue":"3","key":"pone.0268318.ref010","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1093\/bja\/89.3.452","article-title":"Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for Caesarean section under spinal anaesthesia","volume":"89","author":"CM Cowan","year":"2002","journal-title":"British Journal of Anaesthesia"},{"issue":"3","key":"pone.0268318.ref011","first-page":"240","article-title":"Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery","volume":"25","author":"BB Devid","year":"2000","journal-title":"Regional Anesthesia and Pain Medicine"},{"key":"pone.0268318.ref012","first-page":"3","article-title":"Complication of Spinal Anaesthesia in Caesarean Section","volume":"4","author":"FA Naz","year":"2010","journal-title":"Pakistan Journal of Medical and Health Sciences"},{"issue":"1","key":"pone.0268318.ref013","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1471-2253-5-5","article-title":"Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section","volume":"5","author":"J Bogra","year":"2005","journal-title":"BMC Anesthesiol"},{"issue":"4","key":"pone.0268318.ref014","doi-asserted-by":"crossref","first-page":"663","DOI":"10.4103\/aer.AER_131_19","article-title":"Large Dose Bupivacaine 0.5% versus Small Dose in Elective Cesarean Section","volume":"13","author":"HM Ali","year":"2019","journal-title":"Anesth Essays Res"},{"issue":"4","key":"pone.0268318.ref015","doi-asserted-by":"crossref","first-page":"340","DOI":"10.4103\/sja.SJA_17_19","article-title":"Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis","volume":"13","author":"SM Abate","year":"2019","journal-title":"Saudi J Anaesth"},{"issue":"3","key":"pone.0268318.ref016","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1213\/00000539-199709000-00014","article-title":"Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery","volume":"85","author":"B Ben-David","year":"1997","journal-title":"Anesth Analg"},{"issue":"3","key":"pone.0268318.ref017","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1097\/00115550-199924030-00015","article-title":"Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia","volume":"24","author":"EA Hamber","year":"1999","journal-title":"Reg Anesth Pain Med"},{"issue":"4","key":"pone.0268318.ref018","first-page":"67","article-title":"Effect of Intrathecal Fentanyl on subarachnoid block with 0.5% hyperbaric bupivacaine","volume":"2","author":"G Chavan","year":"2014","journal-title":"International J of Healthcare and Biomedical Research"},{"issue":"12","key":"pone.0268318.ref019","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1111\/anae.12034","article-title":"Assessment of block height for satisfactory spinal anesthesia for cesarean section","volume":"67","author":"R Ousley","year":"2012","journal-title":"Anesthesia"},{"issue":"3","key":"pone.0268318.ref020","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1093\/bja\/aer200","article-title":"Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delivery: systematic review and meta-analysis","volume":"107","author":"C Arzola","year":"2011","journal-title":"Br J Anaesth"},{"issue":"5","key":"pone.0268318.ref021","first-page":"747","article-title":"The effect of small dose bupivacaine-fentanyl in spinal anesthesia on hemodynamic nausea and vomiting in cesarean section","volume":"23","author":"M Seyedhejazi","year":"2007","journal-title":"Pakistan journal of medical sciences"},{"issue":"5","key":"pone.0268318.ref022","first-page":"00278","article-title":"Analgesic Effect of Intrathecal Fentanyl as an Adjuvant to Spinal Anaesthesia in Comparison with Spinal Anaesthesia with Bupivacaine Only for Mothers Delivered by Emergency Cesarean Section","volume":"7","author":"KA Yesuf","year":"2017","journal-title":"J Anesth Crit Care Open Access"},{"issue":"5","key":"pone.0268318.ref023","first-page":"673","article-title":"Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes","volume":"20","author":"MS Mebazaa","year":"2010","journal-title":"Middle East Journal of Anaesthesiology"},{"issue":"6","key":"pone.0268318.ref024","first-page":"469","article-title":"Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during cesarean delivery and in early post-operative period","volume":"46","author":"BN Biswas","year":"2002","journal-title":"Indian J Anaesth"},{"issue":"34","key":"pone.0268318.ref025","doi-asserted-by":"crossref","first-page":"8980","DOI":"10.14260\/jemds\/2014\/3156","article-title":"A clinical study of effect of spinal fentanyl on subarachnoid block in parturients","volume":"3","author":"TK Shashikala","year":"2014","journal-title":"Journal of Evolution of Medical and Dental Sciences"},{"issue":"1","key":"pone.0268318.ref026","first-page":"5","article-title":"Effects of intrathecal fentanyl as an adjunct to hyperbaric bupivacaine in spinal anesthesia for elective caesarean section","volume":"16","author":"S Gauchan","year":"2014","journal-title":"Nepal Med Coll J"},{"issue":"2","key":"pone.0268318.ref027","doi-asserted-by":"crossref","first-page":"122","DOI":"10.4103\/1658-354X.152827","article-title":"A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section","volume":"9","author":"HG Venkata","year":"2015","journal-title":"Saudi J Anaesth"},{"issue":"3","key":"pone.0268318.ref028","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1093\/bja\/89.3.452","article-title":"Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for cesarean section under spinal anesthesia","volume":"89","author":"CM Cowan","year":"2002","journal-title":"British Journal of Anaesthesia"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T17:29:13Z","timestamp":1657214953000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0268318"}},"subtitle":[],"editor":[{"given":"Robert Jeenchen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,7,7]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0268318","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,7]]}}}