Comparison of efficacy of low-dose norepinephrine infusion with low-dose boluses of norepinephrine in managing hypotension among parturients undergoing caesarean section under the subarachnoid block

Abstract

: Spinal anesthesia is increasingly popular over general anesthesia due to several advantages. Hypotension can complicate spinal anesthesia during a cesarean section, which could have negative repercussions on the mother and fetus. This study is aimed to compare the efficacy of low-dose norepinephrine infusion with low-dose boluses of norepinephrine in managing hypotension among parturients undergoing cesarean section under subarachnoid block.: Ninety-nine parturients without comorbidities who underwent caesarean section with spinal anesthesia received norepinephrine were considered. They were divided into three groups. Group A- Parturient received a norepinephrine infusion of 1 mcg/min and a rescue bolus of 3 mcg to treat hypotension. Group B- Parturient received a Norepinephrine bolus of 3mcg to treat hypotension. Group C- Parturient received a Norepinephrine bolus of 5 mcg to treat hypotension. All the vitals at different intervals, number of norepinephrine boluses, the total amount of norepinephrine consumed, maximum sensory level achieved, time for baby extraction following subarachnoid block, and any adverse events were documented.No statistical difference was noted in the study group's demographics. However, there was a significant difference in mean systolic blood pressure between the groups from skin incision to baby extraction at T6 and T8. In addition, the mean arterial blood pressure of the two groups differed significantly throughout the period from baby extraction to skin suturing. Between the groups, there was a substantial difference in the total number of boluses needed. The total number of boluses required was maximum in group B, followed by group C. Group A required the minimum number of total norepinephrine boluses.A prophylactic norepinephrine infusion is an effective and straightforward method of reducing the incidence and magnitude of hypotension following spinal anesthesia for cesarean section with no adverse effect.