Background: More than 300 million surgical procedures are performed worldwide annually. About 5% or 15 million surgeries are performed using spinal anesthesia. Bupivacaine hydrochloride is an aminoacil local anesthetic and is the most commonly used local anesthetics. Bupicaine has two common types, namely hyperbaric and isobaric. The difference in density of these two types of drug is believed to influence the diffusion pattern of the drug and thus determine effectiveness, hemodynamics, block spread, and drug side effects. Objective: To compare the effectiveness of hyperbaric bupivacaine with isobaric bupivacaine in patients undergoing lower abdominal surgery. Methods: This study used single blind randomized controlled trial with consecutive sampling method. Ethical permission was obtained and the patient gave consent to the study by filling the informed consent form. 48 patients who underwent the lower abdomen ASA I-II elective surgical procedure at RSUP Dr. Kariadi in accordance to inclusion criteria. Divided into 2 groups; group I received 0.5% hyperbaric bupivacaine 15 mg and group II received isobaric 0.5% 15 mg bupivacaine. Anesthesia is done on sitting position. Pricking examined at L3-4. After anesthesia, patient laid supine on a pillow. Hemodynamic status was recorded, sensoric and motoric blocking level was recorded using pinprick and Bromage test, and side effects also were recorded at 1, 3, 6, 9,12,15 and 30 minutes. Overall data were analyzed using the Mann-Whitney test. Result: Onset of hyperbaric bupivacaine was faster than isobaric bupivacaine (2.00 ± 0.18 minutes versus 5.13 ± 0.34 minutes, p < 0.001). The duration of the isobaric group was longer than hyperbaric (180 ± 22 minutes versus 150 ± 24 minutes, p < 0.001). Blocking level of sensory and motor blocks no significant difference (p> 0.05). For the height of the sensory block, the highest point was T5 in group I and in group II, it was
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