Intrathecal Bupivacaine Versus Bupivacaine Plus Fentanyl for Anesthesia for Cesarean Delivery: A Randomized Double-blind Noninferiority Trial

Br J Anaesth. 2026; 136:584–590. doi: 10.1016/j.bja.2025.09.059 A randomized, double-blind noninferiority trial examined whether increasing the dose of intrathecal bupivacaine alone could provide anesthesia for elective cesarean delivery (CD) that is at least as effective as the commonly used combination of bupivacaine with fentanyl. Although fentanyl is frequently added to spinal bupivacaine to enhance anesthesia quality, its use may introduce disadvantages such as pruritus, increased preparation complexity, cost, and potential medication error. The investigators hypothesized that omitting fentanyl and modestly increasing the bupivacaine dose would achieve comparable clinical effectiveness while minimizing opioid-related side effects.