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Background and Aims This meta-analysis aimed to assess the effect of mixed vs sequential administration of local anesthetic and adjuvant on the onset and duration of spinal block in patients who underwent spinal anesthesia for Cesarean delivery. This meta-analysis aimed to assess the effect of mixed vs sequential administration of local anesthetic and adjuvant on the onset and duration of spinal block in patients who underwent spinal anesthesia for Cesarean delivery.Methods This review was performed following the PRISMA guidelines and using the online databases, Medline, Science Direct, Google scholar and Cochrane library. We registered this review with PROSPERO database (ID-CRD42024585462) in September 2024. We included randomized controlled trials that compared the sequential and mixed administration of local anesthetic with any adjuvant in patients who received spinal anesthesia for Cesarean delivery. The included studies in this review reported onset and duration of block, opioid consumption, time to first request analgesia, pain control after surgery, and associated side effects. We utilized the Review manager software, RevMan for MAC 5.4 to conduct the meta-analysis.Results A total of 12 randomized controlled trials were included in this systematic review and meta-analysis. The duration of sensory block was significantly longer in patients who received sequential administration of local anesthetic with adjuvant compared to mixed group in Cesarean delivery [P=0.004, (CI: 8.42, 45.91)]. The time to first request analgesia was significantly longer by 38.63 minutes in sequential group compared to mixed group [P=0.02, (CI: 6.59, 70.68)].Conclusions The sequential administration of local anesthetics with adjuvant increases duration of sensory and motor block compared to mixed administration in Cesarean delivery. It also increases the time to first request analgesia. There is no significant difference in incidence of adverse events between two groups.