Key result
Prophylactic intramuscular phenylephrine 4mg cuts spinal anaesthesia hypotension by ~63% versus saline.
Why the study?
The incidence of hypotension during spinal anaesthesia for caesarean section is high and affects neonatal outcomes, with ephedrine potentially depressing fetal pH dose-dependently.
Does prophylactic intramuscular phenylephrine or ephedrine reduce the incidence of hypotension in parturients undergoing elective caesarean section under spinal anaesthesia?
Comparison
Intramuscular ephedrine 45mg or phenylephrine (2mg or 4mg) vs saline administered 10 minutes before spinal anaesthesia
Design
Randomized prospective clinical trial
Authors
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Supports IM phenylephrine prophylaxis to cut spinal hypotension in elective cesarean delivery; extends RCT evidence for obstetric vasopressor timing.
RCT (n=200)
Randomly allocated
No
Does prophylactic intramuscular phenylephrine or ephedrine reduce the incidence of hypotension in parturients undergoing elective caesarean section under spinal anaesthesia?
Absolute Event Rate: 32% vs 86%
p-value: p=0.001
Prophylactic intramuscular phenylephrine 4mg and ephedrine 45mg effectively reduce the incidence and severity of hypotension during spinal anaesthesia for caesarean section without adversely affecting neonatal outcomes.
Najeeb et al. (2015) conducted an RCT in Spinal anaesthesia induced hypotension (n=200). Phenylephrine vs. Saline 0.9% was evaluated on Incidence of hypotension (p=0.001). Prophylactic intramuscular phenylephrine 4mg administered 10 minutes before spinal anaesthesia significantly reduced the incidence of hypotension to 32% compared to 86% with saline control.
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