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Category: Volume 06 Issue 11 November 2018
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Title: Maintenance of Arterial Pressure During Spinal Anaesthesia in Caesarean Section – Comparison of Intravenous Phenylephrine Hydrochloride and Ephedrine

Authors: Dr Subha R, Dr Linette J Morris, Dr Suma R

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i11.74

Abstract

Background: Maternal hypotension is common during spinal anaesthesia for caesarean section. It is usually treated with vasopressors in addition to crystalloid infusion and left uterine displacement. This study was undertaken to compare the effect of phenylephrine and ephedrine for the maintenance of arterial pressure during spinal anaesthesia in caesarean section.

Methods: Forty patients in the age group 20-35 years undergoing caesarean section were randomised to receive either phenylephrine 100 µg bolus (Group P) or ephedrine 6mg bolus (Group E) on detection of hypotension (fall in systolic blood pressure <90 mmHg or <20% from the baseline) after spinal anaesthesia. Hemodynamic variables such as heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded immediately after spinal anaesthesia, then every 2 mins for the first 20 mins and thereafter every 5 mins till the end of surgery. The number of boluses given was also noted. Foetal wellbeing was assessed by Apgar score at 1 and 5 mins after delivery.

Result: Group P showed a rapid restoration of blood pressure (both systolic and diastolic) in the 2nd, 4th and 6th minute in a statistically significant manner (P < 0.05). But from 8th to 30th minute there was no statistically significant difference in the arterial blood pressure between the two groups.  In Group P there was statistically significant reduction in HR (P < 0.001). But the requirement of repeated boluses was more in Group P. Regarding neonatal outcome; Apgar score did not show any adverse effect on foetus in both the groups.

Conclusion: Phenylephrine and ephedrine are equally efficacious in maintaining arterial pressures during spinal anaesthesia in the caesarean section. Neonatal outcome was equally good in the two groups.      

Keywords: Spinal anaesthesia, caesarean section, maternal hypotension, vasopressors, phenylephrine, ephedrine, hypotension.

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Corresponding Author

Dr Suma R

Subha Nilayam, TC 8/1941/1, Elipod, Thirumala-PO, Thiruvananathapuram, Kerala, India, Pin 695006

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