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April 9, 2022International Journal of Health SciencesOpen Access

Effects of phenylephrine and ephedrine in prevention and treatment of hypotension during spinal anaesthesia for elective cesarean section

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Key result

Prophylactic phenylephrine resulted in fewer patients requiring rescue doses for hypotension (15% vs 35%) compared to ephedrine during spinal anesthesia for cesarean section, though the difference was reported as not statistically 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?

Population

80 ASA I/II patients posted for elective Cesarean Section

Comparison

100ug IV phenylephrine vs 10mg IV ephedrine

Design

Prospective randomized study

Authors

DCDinesh ChauhanSHS. H.DCDharmishthaben Chakarani

Discussion

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Overview

Phenylephrine may offer better hypotension control than ephedrine in elective cesarean spinal anesthesia; leaves open need for larger RCTs to guide practice.

Study Design

Type

RCT (n=80)

Randomization

chit method

Multicenter

No

Structured PICO

Does phenylephrine prevent hypotension better than ephedrine in parturients undergoing elective cesarean section under spinal anesthesia?

P
Population
80 ASA I and II parturients aged >18 years with normal singleton pregnancies beyond 36 weeks gestation undergoing elective cesarean section under spinal anesthesia.
I
Intervention
Phenylephrine 100 ug IV prophylactic bolus at the time of intrathecal injection, plus rescue boluses of 50 ug whenever maternal systolic blood pressure was less than 90 mmHg
C
Comparator
Ephedrine 10 mg IV prophylactic bolus at the time of intrathecal injection, plus rescue boluses of 5 mg whenever maternal systolic blood pressure was less than 90 mmHg
O
Outcome
Efficacy and safety for the prevention and treatment of hypotension (measured by SBP, DBP, MAP, pulse rate, and need for rescue doses)surrogate

Main Result

Absolute Event Rate: 15% vs 35%

p-value: p=0.7147

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.

Limitations

  • Absence of the measurement of plasma levels of phenylephrine and ephedrine
  • Small sample size

Cite This Study

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 (15% vs 35%) compared to ephedrine during spinal anesthesia for cesarean section, though the difference was reported as not statistically significant.

synapsesocial.com/papers/6a98079ebf4318b353fa933dhttps://doi.org/10.53730/ijhs.v6ns1.5697
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparison between phenylephrine and ephedrine in preventing hypotension during spinal anesthesia for cesarean section2012 · 28 citations
  2. 2Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial2017 · 5 citations
  3. 3A comparative study of infusions of phenylephrine, ephedrine and phenylephrine plus ephedrine on maternal haemodynamics in elective caesarean section2011 · 32 citations
  4. 4Prophylactic Ephedrine Versus Phenylephrine for Maternal Hypotension in Women Undergoing Spinal Anesthesia for Caesarean Section-A Randomized Double Blind Clinical Trial2017 · 2 citations
  5. 5Vasopressors in obstetric anesthesia: A current perspective2015 · 91 citations