Hemodynamic outcomes of phenylephrine versus ephedrine in spinal anesthesia for cesarean section: A prospective randomized study

Background: Spinal anesthesia is the preferred technique for cesarean section due to its rapid onset and safety profile. However, spinal-induced hypotension (SIH) remains a common complication, posing risks to both mother and fetus. Vasopressors such as phenylephrine and ephedrine are routinely used to manage SIH, but their comparative efficacy and safety remain subjects of ongoing debate.Materials and Methods: This prospective, randomized, double-blind study was conducted at the Department of Anaesthesia, Maheshwara Medical College and Hospital, Sangareddy, from April 2022 to May 2023. A total of 120 parturients undergoing elective lower segment cesarean section under spinal anesthesia were randomly allocated to receive either phenylephrine (Group P, n=60) or ephedrine (Group E, n=60) for the management of SIH. Hemodynamic parameters, incidence of bradycardia, nausea, and neonatal Apgar scores were recorded and analyzed.Results: The incidence of hypotension was significantly lower in Group P (16.6%) compared to Group E (33.3%) (p=0.031). Group P had a higher incidence of bradycardia (21.6% vs 5%, p=0.012) but a lower incidence of maternal nausea (6.6% vs 20%, p=0.038). Mean systolic blood pressure was better maintained in Group P (117.8±6.5 mmHg) than Group E (109.3±8.1 mmHg, p<0.001). Neonatal Apgar scores at 1 and 5 minutes were comparable between groups.Conclusion: Phenylephrine demonstrated superior efficacy in maintaining maternal hemodynamic stability with fewer maternal side effects compared to ephedrine, supporting its preferential use for managing SIH during cesarean delivery.