Background: Spinal anesthesia is widely used for gynecological surgeries due to its benefits in pain management and recovery, but it often causes hypotension from sympathetic blockade, particularly with bilateral techniques. Unilateral spinal anesthesia limits this blockade to one side, potentially offering greater hemodynamic stability. This study compared hemodynamic parameters between unilateral and bilateral spinal anesthesia in patients undergoing open gynecological surgery. Patients and Methods: This cross-sectional comparative study at Al-Hussein Teaching Hospital (January-December 2025) included 73 ASA I-II female patients aged 18-65 undergoing elective open gynecological surgery (e.g., cesarean section, hysterectomy, uterine fibroid removal). Group I (n=34) received unilateral spinal anesthesia (hyperbaric bupivacaine 12-15 mg, lateral decubitus position maintained several minutes); Group II (n=39) received bilateral (same dose, supine position). Systolic/diastolic blood pressure, mean arterial pressure, and heart rate were monitored preoperatively, intraoperatively, and up to 180 minutes postoperatively; data were analyzed with SPSS v26 (p≤0.05 significant). Results: Demographics were similar (age ~35.5 years, p=0.905; surgery types p=0.800). Bilateral group showed significantly lower systolic (e.g., 15 min post-induction: 110.6±13.5 vs. 127.3±12.3 mmHg, p=0.001), diastolic (63.2±9.2 vs. 77.1±8.4 mmHg, p=0.001), and mean blood pressure (79.0±7.6 vs. 93.8±6.9 mmHg, p=0.001) from 15 min post-induction to 60 min postoperatively, with recovery by 90 min. Heart rate differences were non-significant (all p>0.05). Conclusion: Unilateral spinal anesthesia provides superior hemodynamic stability with less pronounced blood pressure reductions compared to bilateral in gynecological surgery, supporting its use to minimize hypotension risks.
Ahmed A. Eeda*1, Mohanad Abdul Kareem Hilal2, Haydar Samir Abdullatif2 (2026) studied this question.