Key result
Prophylactic infusion of ephedrine plus phenylephrine reduced the incidence of maternal hypotension compared to ephedrine alone during caesarean section.
Why the study?
Does prophylactic infusion of ephedrine plus phenylephrine reduce maternal hypotension compared to ephedrine alone in parturients undergoing caesarean section under spinal anaesthesia?
RCT (n=60)
Double-blind
Randomized
No
Does prophylactic infusion of ephedrine plus phenylephrine reduce maternal hypotension compared to ephedrine alone in parturients undergoing caesarean section under spinal anaesthesia?
Adding phenylephrine to prophylactic ephedrine infusion significantly reduces the incidence of maternal hypotension, nausea, and vomiting during caesarean section under spinal anaesthesia.
Answers are grounded in this paper and cite their sources.
Combination infusion reduces maternal hypotension versus ephedrine alone in spinal caesarean; supports protocol adoption and further outcome trials.
PURPOSE: Prophylactically administered Ephedrine either in bolus doses or by infusion helps to counteract hypotension following subarachnoid block during caesarean section. Clinical experience suggests that Phenylephrine added to Ephedrine increases the /-agonist activity ratio; there by preventing spinal anaesthesia induced vasoplegia. Hence we took up this study to compare the effect of prophylactic IV infusion of Ephedrine alone versus Ephedrine plus Phenylephrine in caesarean section under spinal anaesthesia for preventing maternal hypotension, nausea, vomiting and neonatal outcome using APGAR score. METHODS: In a randomized double blind fashion, 60 parturient with ASA grade I-II, scheduled for caesarean section were preloaded with ringer lactate of 15 ml/kg. Subarachnoid block was performed with 10 mg hyperbaric Bupivacaine, infusion started with 2mg/min Ephedrine alone (Group-E) or in combination with10 g/min Phenylephrine (Group-E+P) Haemodynamic variables were recorded at regular intervals. The infusion rate was controlled using a predefined algorithm. Hypotension was treated with Ephedrine bolus doses. RESULTS: Incidence of hypotension were less in the Group (E+P) 10% as compared to Group (E) 33.66% with a P-value of <0.05. Total requirement of ephedrine was more in group (E) (42.734.40mg) as compared to Group (E+P) (24.24.09mg) which was statistically significant (P<0.001). Incidence of nausea and vomiting were less in group (E+P) with P-value of 0.04. APGAR scores were comparable in both the groups. CONCLUSION: Phenylephrine added to Ephedrine infusion decreases the incidence of hypotension, nausea & vomiting.
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Lokesh et al. (2014) conducted an RCT in Hypotension during caesarean section under spinal anaesthesia (n=60). Ephedrine plus Phenylephrine infusion vs. Ephedrine alone infusion (2mg/min) was evaluated on Incidence of hypotension (systolic blood pressure <100mmHg or <80% of baseline before delivery) (p=0.015). Prophylactic infusion of ephedrine plus phenylephrine reduced the incidence of maternal hypotension compared to ephedrine alone during caesarean section.
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