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October 10, 2017Iranian Red Crescent Medical Journal

Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial

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Key result

Phenylephrine significantly differed from ephedrine in hemodynamic parameters (P<0.0001), with ephedrine causing more fetal acidosis and maternal nausea and vomiting (P=0.03).

Why the study?

Does intravenous phenylephrine compared to ephedrine improve hemodynamics and reduce side effects in pregnant females experiencing hypotension during spinal anesthesia for elective cesarean section?

Population

124 pregnant females admitted for elective cesarean section under spinal anesthesia

Comparison

Intravenous phenylephrine bolus administered in… vs Intravenous ephedrine bolus administered in case…

Design

RCT, Block randomization sampling method, Double-blind

Authors

HVHedayatollah VakiliShiraz University of Medical SciencesEHEnayati HasanZahedan University of Medical SciencesADAlireza DashipourZahedan University of Medical Sciences

Discussion

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Overview

Phenylephrine may be preferred over ephedrine for spinal hypotension in cesarean delivery; leaves open confirmation in larger trials on neonatal outcomes.

Study Design

Type

RCT (n=124)

Blinding

Double-blind

Randomization

Block randomization

Multicenter

No

Structured PICO

Does intravenous phenylephrine compared to ephedrine improve hemodynamics and reduce side effects in pregnant females experiencing hypotension during spinal anesthesia for elective cesarean section?

P
Population
124 pregnant females undergoing elective cesarean section under spinal anesthesia.
I
Intervention
Intravenous phenylephrine bolus (50 mcg or 100 mcg) administered in case of hypotension
C
Comparator
Intravenous ephedrine bolus (5 mg or 10 mg) administered in case of hypotension
O
Outcome
Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and pulse rate)surrogate

Main Result

p-value: p=<0.0001

Phenylephrine (50 mcg) is recommended over ephedrine for managing hypotension during spinal anesthesia for cesarean section due to better fetal acid-base outcomes and fewer maternal side effects.

Cite This Study

Vakili et al. (2017) conducted an RCT in Maternal hypotension due to spinal anesthesia for elective cesarean section (n=124). Phenylephrine vs. Ephedrine (5 mg or 10 mg bolus) was evaluated on Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and pulse rate) (p=<0.0001). Phenylephrine significantly differed from ephedrine in hemodynamic parameters (P<0.0001), with ephedrine causing more fetal acidosis and maternal nausea and vomiting (P=0.03).

synapsesocial.com/papers/6a997af3210dbea31328ec6chttps://doi.org/10.5812/ircmj.13978
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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. 2A Comparative Study of Ephedrine and Phenylephrine in Averting Hypotension during Cesarean Section under Spinal Anesthesia2022
  3. 3Hemodynamic outcomes of phenylephrine versus ephedrine in spinal anesthesia for cesarean section: A prospective randomized study2023
  4. 4Ephedrine versus Phenylephrine: Prevention of Hypotension during Spinal Anaesthesia for Cesarean Section and Effects on the Fetus2017
  5. 5A prospective, randomized, double-blind, comparative study of phenylephrine and ephedrine in treating hypotension during cesarean section under spinal anesthesia: Vasoconstrictors for Hypotension During CS2021