Effects of phenylephrine and ephedrine in prevention and treatment of hypotension during spinal anaesthesia for elective cesarean section

A randomized controlled study

https://doi.org/10.53730/ijhs.v6nS1.5697

Authors

  • Dinesh Chauhan Department of Anesthesiology, Dhiraj Hospital, Sumandeep Vidypith University, Waghodia, Piparia, Vadodara,Gujarat
  • Tejash Sharma Department of Anesthesiology, Dhiraj Hospital, Sumandeep Vidypith University, Waghodia, Piparia, Vadodara,Gujarat
  • Dharmishthaben Chakarani Department of Anesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research center, Sumandeep Vidyapeeth (An Institute Deemed to be university), Piparia, Vadodara, Gujarat, India

Keywords:

neuraxial block, vasopressor, pregnancy, hemodynamics

Abstract

Introduction: Hypotension and bradycardia are common side effects of spinal anaesthesia. It can have a potentially deleterious maternal and fetal impact. Phenylephrine is preferred vasopressor in prevention and treatment of post spinal hypotension (PSH) and Ephedrine investigated as an alternative to phenylephrine with promising results. Aim: To compare the efficacy and safety of Ephedrine with Phenylephrine for the prevention and treatment of hypotension under spinal anesthesia for cesarean delivery. Methods: This prospective, randomized study was done at tertiary care centre. Total 80patients of ASA I/II posted for elective Cesarean Section were randomly divided into 2 equal groups, Group P (Phenylephrine) received 100ug of Inj. Phenylephrine i.v. and Group E (Ephedrine) received 10mg of Inj. Ephedrine i.v. Result: Incidence of bradycardia was higher in phenylephrine group after induction. SBP, DBP and mean blood pressure measured during pre-operative, per-operative and post-operative periods in both groups showed low incidence of hypotension in Group P as compared to Group E. Conclusion: Phenylephrine is more efficient in managing hypotension during spinal anaesthesia for elective caesarean delivery. Neonatal outcome remains equally good in both the groups. 

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References

Deb Sanjay Nag, Devi Prasad Samaddar, Abhishek Chatterjee, Himanshu Kumar, Ankur Dembla, Vasopressors in obstetric anesthesia: A current perspective; World J Clin Cases:2015 Jan;3(1): 58-64.

Ahmed Hasanin, Ali M. Mokhtar a, Ahmed A. Badawy a, Reham Fouad, Post-spinal anesthesia hypotension during cesarean delivery, a review article; Egyp J Anaesth. 2017:33(8):189–193.

Montoya BH., Oliveros C.I., Moreno DA, Managing hypotension induced by spinal anesthesia for caesarean section; Rev. Col. Anest. Mayo-Julio 2009:37(2) 131- 140.

Anna Lee, MPH, PhD, Warwick D. Ngan Kee, MBChB, MD, FANZCA, and Tony Gin, MBChB, MD, FANZCA, FRCA, A Quantitative, Systematic Review of Randomized Controlled Trials of Ephedrine Versus Phenylephrine for the Management of Hypotension During Spinal Anesthesia for Cesarean Delivery, AnesthAnalg 2002;6 (94):920-932.

Atashkhoyi Simin, Fardiazar Zahra, Hatami Marandi Pouya, Torab Reza, Comparison the effect of ephedrine and phenylephrine in treatment of hypotension after spinal anesthesia during cesarean section; OJOG 2012: (2):192-196.

Edno Magalhães, TSA, Catia Sousa Govêia, TSA, Luís Cláudio de Araújo Ladeira, TSA2, Bruno Góis Nascimento, SérgioMurilo Cavalcante Kluthcouski, Ephedrine versus Phenylephrine: Prevention of Hypotension during Spinal Block for Cesarean Section and Effects on the Fetus; Rev Bras Anestesiol ARTIGO CIENTÍFICO, 2009; 59:(1): 11-20.

R. Anitha Preethi, A. Pushparani, Prospective randomized double blinded comparative study on the effects of ephedrine and phenylephrine on fetal outcome and their effects on hypotension during elective cesarean section; IJCA, July-September, 2018;5(3):321-326.

Sabyasachi Das, Soma Mukhopadhyay, Mohanchandra Mandal, Sukanta Mandal, Sekhar Ranjan Basu, A comparative study of infusions of phenylephrine, ephedrine and phenylephrine plus ephedrine on maternal haemodynamics in elective caesarean section; IJA, 2011 Nov: 55(6):578-583.

Hedayatollah Vakili, Hasan Enayati, and Alireza Dashipour, Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial; ircmj: 2017 October; 19(10):e13978.

Arun Kumar Natarajan, Nongthombam Ratan Singh, Laithangbam Pradipkumar Singh, Rajkumari Shanti Devi, N. Anita Devi, Ashem Jack, Comparison of intravenous bolus phenylephrine and intravenous ephedrine during crystalloid coloading in ameliorating hypotension under spinal anesthesia for caesarean section; J Med. Soc: Dec 2015, 29(3):155-159.

Iqra Nazir, Mubasher A. Bhat, Syed Qazi, Velayat N. Buchh, Showkat A. Gurcoo, Comparison between phenylephrine and ephedrine in preventing hypotension during spinal anesthesia for cesarean section; JOACC: Dec 2012: 2(2):92-97.

Aidah Alkaissi, Qussai Ussbah and Aisar Al-Bargouthi, Prophylactic Ephedrine Versus Phenylephrine for Maternal Hypotension in Women Undergoing Spinal Anesthesia for Caesarean Section-A Randomized Double Blind Clinical Trial; J Biomedical Sci. 2017, 6(2):12.

Abatneh Feleke Agegnehu, Amare Hailekiros Gebreegzi, Girmay Fitiwi Lemma, Nigussie Simeneh Endalew and Endale Gebreegziabher Gebremedhn, Effectiveness of Intravenous Prophylactic Phenylephrine for the Prevention of Spinal Anaesthesia Induced Hypotension during Caesarean Section. A Prospective Observational Study; J Anesth Clin Res, an open access journal, Nov 2017: 8(11): a4-360.

Balki M, Carvalho JC. Intraoperative nausea and vomiting during caesarean section under regional anesthesia. Int J Obstet Anesth 2005;14:230-41.

Corke BC, Dutta S, Ostheiner GW, Weiss JB, Alper MH, Spinal anaesthesia for caesarean section. The influence of hypotension on neonatal outcome. Anaesthesia, June 1982;37: 658-662.

Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I, Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section. Anesthesiology, Dec 1999; 91: 1571-1576.

Olang P.R., D.C. WAMALWA and OMONDI OGUTU, Effects of spinal anesthesia during elective Cesarean section on neonatal outcome at the Kenyatta national hospital. East African Medical Journal; Oct 2012; 89: 317-321.

Magalhaes E, Goveia CS, Ladeira L, Nascimento B, Kluthcouski S Ephedrine versus phenylephrine: prevention of hypotension during spinal block for Cesarean section and effects on the fetus. Rev Bras Anestesiol.Feb 2009; 59: 11-20.

Kinsella SM, Lateral tilt for pregnant women. Why 15 degrees? Anaesthesia; Sep 2003: 58: 835-836.

Erler I, Gogarten W, Prevention and treatment of hypotension during caesarean delivery. Anasthesiol Intensivemed Notfallmed Schmerzther; March 2007; 42: 208-213.

Saravanan, S., Kocarev, M., Wilson, R.C., Watkins, E., Columb, M.O. and Lyons, G. Equivalent dose of ephedrine and phenylephrine in the prevention of post- spinal hypotension in caesarean section. British Journal of Anaesthesia, Jan 2006;96: 95-99.

Moran DH, Dutta S, Perillo M, Laporta RF, Bader A, Phenylephrine in the prevention of hypotension following spinal anaesthesia for caesarean delivery. J Clin Anaesth 1991; 3: 301-305.

Veeser M, Hofmann T, Roth LR, Klöhr S, Rossaint R, et al. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand 2012, 56: 810-816.

Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anesthesia for Caesarean section. Br J Anaesth 1996,76: 61-65.

Ngan Kee WD, Khaw KS, Lau TK, Ng FF, Chui K, Ng KL. Randomised double-blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anae thesia for non-elective Caesarean section. Anaesthesia 2008;63:1319–26.

Robson SC, Boys RJ, Rodeck C, Morgan B. Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth. 1992;68:54–9.

Prakash S, Pramanik V, Chellani H, Salhan S, Gogia AR Maternal and neonatal effects of bolus administration of ephedrine and phenylephrine during spinal anaesthesia for caesarean delivery: a randomized study. Int J Obstet Anesthesia 2010, 19: 24-30.

Bhardwai N, Jain K, Arora S, Bharti N A comparison of three vasopressoes for tight control of maternal blood pressure during spinal anesthesia: Effect on maternal and fetal outcome. J Anaesthesiol Clin Pharmacol 2013, 29: 26-31.

Gunda CP, Malinowski J, Tegginmath A, Venkatesh G, Suryanarayana VG, et al. Vassopresor choice for hypotension in elective Cesarean section: Ephedrine or Phenylephrine. Arch Med Sci 2010, 6: 257-263.

Lee A, Ngan Kee WD, Gin T. A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective caesarean delivery. AnesthAnalg. 2004;98:483–90.

Nazir I, Bhat MA, Qazi S, Buchh VN, Gurcoo SA Comparison between phenylephrine and ephedrine in preventing hypotension during spinal anesthesia for cesarean section. J Obstet Anaesth Crit Care 2012, 2: 92-97.

Macarthur A, Riley ET Obstetric anesthesia controversies: vasopressor choice for postspinal hypotension during cesarean delivery. Int Anesthesiol Clin 2007, 45: 115-32.

Adigun TA, Amanor-Boadu SD, Soyannwo SD. Comparison of intravenous ephedrine with phenylephrine for the maintenance of arterial blood pressure during elective caesarean section under spinal anaesthesia. Afr J Med Med Sci 2010;39:13-20.

Published

09-04-2022

How to Cite

Chauhan, D., Sharma, T., & Chakarani, D. (2022). Effects of phenylephrine and ephedrine in prevention and treatment of hypotension during spinal anaesthesia for elective cesarean section: A randomized controlled study. International Journal of Health Sciences, 6(S1), 3955–3969. https://doi.org/10.53730/ijhs.v6nS1.5697

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