Comparison of Efficacy of Bolus Dosages of Norepinephrine, Phenylephrine, and Ephedrine in Treating Post-Spinal Hypotension During Elective Cesarean Section: A Randomized Double-Blinded Controlled Trial
Abstract
Background and Aims: Currently, the widely used vasopressors for spinal induced hypotension after caesarean deliveries are phenylephrine and ephedrine. Norepinephrine is a substitute vasopressor during caesarean deliveries due to its ability in treating hypotension while maintaining heart rate (HR). The objective of current research was to compare the safety and efficiency among bolus dosages of norepinephrine (6mcg), phenylephrine(100mcg), and Ephedrine (6mg) in treating post spinal hypotension during elective caesareans.
Material and methods: Following the ethical committee's approval and obtaining written informed consent, ASA grade II and III patients aged between 18-35 years undergoing elective LSCS were randomized into 3 groups of 45 each among A, B and C (n=45) to receive norepinephrine, phenylephrine or ephedrine, boluses respectively after 20% fall in blood pressure. In present research, the efficacy and safety profiles of all three drugs along with maternal and neonatal outcomes were compared.
Results: Total number of drug boluses needed for rescuing maternal hypotension in group A (1.78 ± 0.74 vs 1.93 ± 0.69 vs 2.38 ± 0.81, F value = 7.89; p-value <0.001) was less compared with group B and group C. Tachycardia was high in group C (26.7% vs 15.6% vs 37.8%, p=0.001) than in groups A & B. Incidence of bradycardia (HR<60bpm) was higher in group B (20% vs 24.4% vs 6.7%, p=0.001). Maternal complications were comparable among groups. There were no significant statistical variations in neonatal results among groups.
Conclusions: Norepinephrine is a potent drug and has a better hemodynamic profile than phenylephrine and ephedrine because of fewer fluctuations in the heart rate and perhaps cardiac output.
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References
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