What question did this study set out to answer?

To evaluate the efficacy of preoperative caffeine in reducing spinal anesthesia-induced hypotension during cesarean delivery.

January 17, 2026Open Access

Caffeine before cesarean delivery: a novel preventive strategy against spinal hypotension, a double blind placebo-controlled trial

Key Points

To evaluate the efficacy of preoperative caffeine in reducing spinal anesthesia-induced hypotension during cesarean delivery.
Randomized controlled trial with 90 patients undergoing elective cesarean delivery
Participants received either 200 mg oral caffeine or placebo 30 minutes before the procedure
Recorded hemodynamic parameters, incidence and severity of hypotension, and other postoperative effects
Caffeine reduced hypotension incidence to 9% compared to 33% in the placebo group
Severe hypotension was absent in the caffeine group
Caffeine group showed delayed hypotension onset and lower ephedrine requirements
Postoperative nausea and vomiting occurred in 2% of caffeine patients versus 20% in placebo
Lower rates of post-dural puncture headache were observed in the caffeine group (2% vs. 16%)

Abstract

Abstract Background Spinal anesthesia-induced hypotension is a common complication during cesarean delivery, often requiring vasopressor support, and is associated with maternal discomfort. Caffeine, a central nervous system stimulant with well-documented cardiovascular effects, may provide a simple adjunct to enhance hemodynamic stability. We aimed to evaluate the efficacy of a single preoperative 200 mg oral caffeine dose in reducing the incidence and severity of hypotension following spinal anesthesia in healthy patients undergoing elective cesarean delivery. Methods In this randomized controlled trial, 90 patients classified as ASA II and scheduled for elective cesarean delivery under spinal anesthesia were assigned to receive either 200 mg oral caffeine or a placebo 30 min before the procedure. Hemodynamic parameters, the incidence and severity of hypotension, baseline and 60 min post-administration serum caffeine levels, ephedrine requirements, incidence of postoperative nausea and vomiting, and post-dural puncture headache were recorded and analyzed. Results Caffeine administration significantly reduced the incidence of hypotension (9% vs. 33%, p < 0.05). Severe hypotension was not observed in the caffeine group. Patients in the caffeine group demonstrated greater hemodynamic stability, with a delayed onset of hypotension and reduced ephedrine requirements. No significant differences were observed in the incidence of bradycardia, tachycardia, or reactive hypertension. Neonatal outcomes were comparable between the groups. Additionally, caffeine was associated with lower rates of postoperative nausea and vomiting (2% vs. 20%) and post-dural puncture headache (2% vs. 16%) at 24 h. Conclusion Preoperative administration of 200 mg oral caffeine is a cost-effective strategy for reducing spinal anesthesia-induced hypotension, the incidence of postoperative nausea and vomiting, and post-dural puncture headache in healthy patients undergoing elective cesarean delivery. These findings support further investigation of the role of caffeine as an adjunct in obstetric anesthesia. Trial registration The study was registered by the principal investigator (M. Helmy) at ClinicalTrials.gov under the identifier NCT07076654 on July 11, 2025. Graphical Abstract

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