Comparison of Haemodynamics Between Fractionated and Bolus Injection in Spinal Anaesthesia for Elderly Patients: A Randomized Controlled Trial

Informed written consent will be taken from all the patients

Patients will be randomly divided into 2 group , Group F ( Two third dose (2ml) injected initially 90 sec gap and remaining one third dose(1ml) given and Group B ( 3ml will be given 2.5ml of o.5%  hyperbaric bupivacaine with 0.5ml of fentanyl 25 microgram  Utilising a computer generated  table of random numbers before starting the procedure with concealment by sealed envelope method

on the day of surgery , patient shifted onto the operating room and monitor attached .

In the both spinal anaesthesia will be performed by anaesthesiologist

patient in sitting position at L3-L4 space with using 25 Guage Quincke spinal needle on each group . first 500ml of ringer lactate solution bolus over 30minutes followed by 500ml/hr onflow .

If MAP less than 65 mmHg iv fluid 100ml within 10 mins if still reduced then phenylephrine 20 microgram iv will be given ( total dose will documents till MAP become more than 65 mmHg. Data documentation primarily hemodynamics monitoring . every 2mins for  first 10 minutes then every 5 minutes for next hours then every 15mins for 4 hours followed by every 4 hours up to 24 hours postoperatively .secondary outcomes as from intraoperatively , onset evaluated by loos of cold sensation ( sensory block ) and onset of motor block by modified Bromage score and two segment regression time.