Key result
Crystalloid co-loading significantly reduced the incidence of spinal anaesthesia-induced hypotension compared to pre-loading (37.8% vs 60.0%, p=0.034) during caesarean section.
Why the study?
Evidence comparing crystalloid pre-loading and co-loading in parturients undergoing cesarean section under spinal anesthesia was lacking in Bangladesh.
Does crystalloid co-loading prevent spinal anesthesia induced hypotension in parturients undergoing cesarean section compared to pre-loading?
RCT (n=90)
Single-blind
Odd and even number allocation
No
Does crystalloid co-loading prevent spinal anesthesia induced hypotension in parturients undergoing cesarean section compared to pre-loading?
Absolute Event Rate: 37.8% vs 60%
p-value: p=0.034
Crystalloid co-loading is more effective than pre-loading in preventing spinal anesthesia-induced hypotension during cesarean delivery.
Crystalloid co-loading reduces hypotension versus pre-loading; supports preference in spinal anesthesia for cesarean delivery.
Context: There is lack of evidence on comparison of crystalloid pre-loading and co-loading in parturients undergoing cesarean section operation under spinal anesthesia in Bangladesh. Hence, the present study was designed to compare the efficacy of crystalloid pre-loading and co-loading in preventing spinal anesthesia induced hypotension and heart rate variability during caesarean delivery. Methods: This single blinded randomized controlled clinical trial was conducted in the Department of Anaesthesia, Analgesia & Intensive Care, Dhaka Medical College Hospital, Dhaka, Bangladesh, from January 2013 to December 2014. A total of 90 patients were selected - 45 patients of group I received co-loading with Ringer’s lactate solution, while another 45 patients of group II received a pre-loading with the same fluid. Blood pressure and heart rate were recorded in both the groups with 3-minute intervals from the beginning of the subarachnoid block for the first 20 minutes, and then with 5-minute intervals up to one hour. Ephedrine was used as the primary rescue drug to treat hypotension. When ephedrine failed to treat hypotension, adrenaline was administered as a potent vasopressor. Results: The incidence of hypotension was 17 (37.8%) in group I (co-loading group) and 27 (60%) in group II (pre-loading group), which was significantly higher in group II (p<0.05). Comparatively higher heart rate was observed in group II, but not statistically significant. Ephedrine was required in 17 cases (37.8%) in group I and 27 cases (60%) in group II. Mean ephedrine required was 9.2±3.6 mg in group I and 11.5±4.3 mg in group II. The difference was statistically significant (p<0.05). Adrenaline was administered in 1 case (2.2%) in group I and in 2 cases (4.4%) in group II, which was not statistically significant (p>0.05). Conclusion: Severity of hypotension and increased ephedrine requirement were evident in patients who received crystalloid pre-loading (group II), which means crystalloid co-loading (group I) was more capable to prevent spinal anaesthesia induced hypotension. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 12-17
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Mohammad et al. (2021) conducted an RCT in Spinal anaesthesia induced hypotension during caesarean section (n=90). Crystalloid co-loading (Ringer's lactate) vs. Crystalloid pre-loading (Ringer's lactate 20 ml/kg over 20 minutes before spinal anaesthesia) was evaluated on Incidence of spinal anaesthesia induced hypotension (p=0.034). Crystalloid co-loading significantly reduced the incidence of spinal anaesthesia-induced hypotension compared to pre-loading (37.8% vs 60.0%, p=0.034) during caesarean section.
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