Background:
An adjuvant of local anesthetics (LA) with spinal anesthesia (SA) increases the SA length.
Aim:
This study investigates the impact of intrathecal addition of dexamethasone to bupivacaine on improving post-spinal anesthesia hypotension (PSAH) in elderly patients.
Primary Outcomes
Amount of fluids and vasoactive drugs needed to maintain blood pressure.
Secondary Outcomes

Demographic data, including duration of anesthesia, duration of surgery, gender, age, BMI, chronic medical disease, and ASA.
Blood pressure: systolic and diastolic blood pressure and mean arterial blood pressure.
Postoperative VAS score of pain assessment.
Postoperative shivering.
Postoperative nausea and vomiting.
Post-dural puncture headache (PDPH).

Patients and Methods:
90 patients were scheduled for endoscopic bloodless urologic surgeries under SA, including cystoscopic and ureteroscopic surgeries. They were divided into 2 groups; 1^st group (A) included 45 patients who received 8mg (2ml) dexamethasone in addition to 3ml bupivacaine 0.5% intrathecally, and 2^nd group (B) included 45 patients who received only 3ml 0.5% bupivacaine intrathecally as a control group.
Results:
The dexamethasone group was significantly higher in mean, systolic, and diastolic blood pressure readings. The dexamethasone group received significantly lower ephedrine dose and intravenous fluids. The two groups had no significant differences in postoperative nausea and vomiting, but the postoperative pain score was significantly better.
Conclusion:
Using dexamethasone in combination with bupivacaine in patients who underwent SA would decrease the amounts of IV fluids and doses of vasopressors to maintain blood pressure. Further research is needed to confirm such findings.