COMPARATIVE STUDY BETWEEN NOREPINEPHRINE BOLUS AND NOREPINEPHRINE INFUSION IN PREVENTION OF POST-SPINAL HYPOTENSION IN CESAREAN SECTION

Abstract

Background: Post-spinal hypotension in patients of cesarean section (CS) remains a common scenario in our practice with an incidence of hypotension is up to 71%. Norepinephrine is potent α adrenergic receptor and a weak β adrenergic agonist. It is suitable for maintaining blood pressure as phenylephrine and ephedrine in cesarean section. Objectives: The aim of this work was to evaluate and compare the effects of prophylactic bolus norepinephrine and norepinephrine infusion on blood pressure during spinal anesthesia for cesarean section. Patients and Methods: Eighty patients of American Society of Anesthesiology (ASA) physical status (I-II), aged (20-40) years old and undergoing to elective cesarean section who randomly classified into 2 equal groups: Group (I) received prophylactic bolus norepinephrine (10 μg) and Group (II) received prophylactic norepinephrine infusion (0.05 μg/kg/min). Fixed rate infusion and bolus dose of norepinephrine started immediately after spinal anesthesia. Results: There were significant differences between group I and group II as regards maternal hemodynamic variables which was needed multiple doses of noradrenalin in group II. There were no significant differences in the intraoperative nausea and vomiting between groups. There were no significant differences between group I and group II as regards the fetal outcome. Conclusion: Prophylactic bolus of norepinephrine and prophylactic norepinephrine infusion were effective for maintaining blood pressure of spinal anesthesia in cesarean section, and safe on maternal and fetal status. Norepinephrine infusion was superior to the intermittent boluses.