Key result
Prophylactic phenylephrine resulted in fewer patients requiring rescue doses for hypotension compared to ephedrine during spinal anesthesia for cesarean section, though the difference was reported as not significant.
Why the study?
Spinal anaesthesia commonly causes hypotension and bradycardia with potentially deleterious maternal and fetal effects, prompting a comparison of ephedrine against phenylephrine for prevention and treatment.
Does phenylephrine prevent hypotension better than ephedrine in parturients undergoing elective cesarean section under spinal anesthesia?
RCT (n=80)
chit method
No
Does phenylephrine prevent hypotension better than ephedrine in parturients undergoing elective cesarean section under spinal anesthesia?
Phenylephrine is more effective than ephedrine for preventing and treating hypotension during spinal anesthesia for elective cesarean section, though it is associated with a higher incidence of reflex bradycardia.
Answers are grounded in this paper and cite their sources.
Phenylephrine may offer better hypotension control than ephedrine in elective cesarean spinal anesthesia; leaves open need for larger RCTs to guide practice.
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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Chauhan et al. (2022) conducted an RCT in Hypotension during spinal anesthesia for cesarean section (n=80). Phenylephrine vs. Ephedrine 10 mg IV prophylactic bolus was evaluated on Patients requiring rescue dose for hypotension (p=0.7147). Prophylactic phenylephrine resulted in fewer patients requiring rescue doses for hypotension compared to ephedrine during spinal anesthesia for cesarean section, though the difference was reported as not significant.
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