Ephedrine Versus Phenylephrine as a Vasopressor for Spinal Anaesthesia-induced Hypotension in Parturients Undergoing High-risk Caesarean Section: Meta-analysis, Meta-regression, and Trial Sequential Analysis

Abstract

(Int J Obstet Anesth. 2019;37:16–28) Hypotension is a common adverse effect of spinal anesthesia for cesarean section. In this setting, phenylephrine is the preferred vasopressor for the treatment of spinal-induced hypotension because it has been associated with a lower rate of fetal acidosis compared with ephedrine. However, this conclusion was based on studies performed in low-risk healthy parturients. Some studies in high-risk parturients undergoing spinal anesthesia for cesarean section, have since been performed. They have not found a difference in umbilical artery pH when ephedrine as compared with phenylephrine was used to treat hypotension. However, the retrospective design of some of these studies is prone to bias. Therefore, the current investigators decided to conduct a meta-analysis of prospective, randomized controlled trials comparing ephedrine versus phenylephrine for the treatment or prevention of spinal-induced hypotension during high-risk cesarean sections.