Key result
Prophylactic intravenous atropine did not prevent a decline in blood pressure from baseline during the first 60 minutes of spinal anesthesia compared to active prophylaxis (p > 0.05).
Why the study?
The study was conducted to assess the prophylactic efficacy of intravenous atropine for the prevention of hypotension after spinal anesthesia in parturients undergoing cesarean delivery.
Does intravenous atropine prophylaxis prevent post-spinal hypotension in pregnant women undergoing elective cesarean delivery?
RCT (n=66)
randomized
No
Does intravenous atropine prophylaxis prevent post-spinal hypotension in pregnant women undergoing elective cesarean delivery?
p-value: p=> 0.05
Prophylactic intravenous atropine does not prevent post-spinal hypotension in women undergoing elective cesarean delivery.
Atropine prophylaxis is ineffective against post-spinal hypotension in cesarean delivery; does not support routine use and confirms lack of benefit in RCT evidence.
Background: The main objective of this study is to assess the prophylactic efficacy of intravenous atropine for the prevention of hypotension after spinal anesthesia in a parturient who underwent cesarean delivery under spinal anesthesia. Method: A randomized controlled trial study was conducted at Dilla University hospital. Pregnant women scheduled for elective cesarean section were randomized to either atropine prophylaxis (n = 33) or active prophylaxis (n = 33) for prevention of post-spinal hypotension. Sample sizes were calculated using a G-power version 3.1.9.2 getting a total of 66 participants. Intraoperative blood pressure, heart rate, and incidence of postoperative nausea and vomiting were assessed. Paired sample t-test was used to compare each group change from baseline. Independent t-test and Manny Whitney tests were used based on the distribution of data. A statistically significant difference was determined at a p-value of ≤05. Result: Both systolic and diastolic blood pressure declined from the baseline in both groups after spinal anesthesia. Atropine didn't prevent a decline in blood pressure from the baseline during the first 60 min of initiation of spinal anesthesia (p > 0.05). Heart rates at the 15th and 20th minute were higher in the atropine group (p < 0.05). There is no statistically significant difference between groups regarding mean Apgar score, and neonatal outcome. The total crystalloid fluid given during the perioperative period is higher in the active prophylaxis group with a mean of 2151.5 ml compared to 1651.52 ml in the atropine group p = 0.002. The incidence of intraoperative nausea and vomiting was higher in the active prophylaxis group compared to the atropine group but the difference is not statistically significant p > 0.05 as it was shown in the figure below. Conclusion: Prophylactic administration of atropine didn't prevent a decline in blood pressure from baseline. The incidence of nausea and vomiting was lower in the atropine group with no statistically significant difference.
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Aweke et al. (2021) conducted an RCT in hypotension after spinal anesthesia (n=66). intravenous atropine vs. active prophylaxis was evaluated on decline in blood pressure from the baseline during the first 60 min of initiation of spinal anesthesia (p=> 0.05). Prophylactic intravenous atropine did not prevent a decline in blood pressure from baseline during the first 60 minutes of spinal anesthesia compared to active prophylaxis (p > 0.05).
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