Comparison of intravenous bolus phenylephrine and intravenous ephedrine during crystalloid coloading in ameliorating hypotension under spinal anesthesia for caesarean section

Abstract

Background: Maternal hemodynamic changes are common during spinal anesthesia for caesarean delivery and many agents are used for treating hypotension. In this study, we compared the efficacy of ephedrine and phenylephrine in ameliorating hypotension in spinal anesthesia for caesarean delivery during crystalloid coloading and their effect on fetal outcome. Materials and Methods: A total of 80 American Society of Anesthesiologists (ASA) grade I/II patients undergoing elective cesarean delivery under spinal anesthesia with a normal singleton pregnancy beyond 36 weeks gestation were randomly allocated into two groups of 40 each. Group 1 received bolus dose of intravenous (IV) ephedrine 6 mg and group 2 received bolus doses of IV phenylephrine 100 μg. Hemodynamic variables like blood pressure and heart rate (HR) were recorded every 2 min up to delivery of the baby and thereafter every 5 min. Neonatal outcome was assessed using Apgar score at 1 min and 5 min and neonatal umbilical cord blood pH values. Results: There was no difference found in managing hypotension between the group 1 and group 2. The incidence of bradycardia was higher in phenylephrine group (group 2). The differences in umbilical cord pH, Apgar score, and birth weight between the two groups were found to be statistically insignificant. Conclusion: Phenylephrine and ephedrine are equally efficient in managing hypotension during spinal anesthesia for elective caesarean delivery. There was no difference between the two vasopressors in the incidence of true fetal acidosis and neonatal outcome.