Impact of Intravenous Bolus Norepinephrine versus Ephedrine on Post-Spinal Hypotension during Cesarean Section in Libyan Patients

Spinal anaesthesia-induced hypotension (SAIH) is a frequent and significant complication during Cesarean section (CS) performed under neuraxial blockade, with the potential to cause adverse maternal and neonatal outcomes. The main management involves administration of vasopressors such as Ephedrine (EP) and phenylephrine. Recently, Norepinephrine (NE) has gained considerable attention as a viable alternative due to its favorable hemodynamic profile. This study was conducted to compare the efficacy and safety of NE versus Ephedrine for the treatment of established SAIH in a specific cohort of Libyan patients undergoing CS. This retrospective comparative study included 120 female patients undergoing elective CS under spinal anesthesia, randomized into two groups (n=60 each): the Norepinephrine (NE) group received 8 µg bolus of NE, and the ephedrine (EP) group received 10 mg bolus of Ephedrine (EP) for treating hypotension (Systolic Blood Pressure (SBP) 0.05). Intravenous bolus norepinephrine was more effective than ephedrine in maintaining maternal blood pressure (MAP and SBP) during the critical period following spinal anesthesia for Cesarean section. However, Norepinephrine was associated with a higher incidence of maternal bradycardia. Both vasopressors demonstrated comparable neonatal outcomes.