A Comparative Study to Evaluate the Effect of Norepinephrine and Phenylephrine in the Treatment of Post Spinal Hypotension for Caesarean Section
,
Abstract
Background: Maternal hypotension due to spinal anaesthesia in caesarean section is commonly seen. Alongwith fluid loading, phenylephrine is used to manage the hypotension. However, this drug is associated with cardiovascular side effects.
Methods: This is a prospective double blinded study which was conducted on 100 term parturients scheduled from elective caesarean section under spinal anaesthesia, randomly assigned into two groups. After spinal anaesthesia patients of group N and P were treated with norepinephrine (5mcg) and phenylephrine (50mcg) respectively as an IV bolus for hypotension. Blood pressure, heart rate, number of bolus doses given, and neonatal APGAR score was noted.
Results: Patients of both groups were comparable with respect to haemodynamic parameters (HR, SBP, DBP, AND MAP). Incidence of bradycardia was higher in group P (22%, n=11) compared to group N (14%, n=7). Neonatal APGAR scores at different time intervals were similar in both groups.
Conclusion: Intermittent boluses of norepinephrine were effective in the treatment of spinal anaesthesia induced hypotension during caesarean section and can be considered as an alternative to phenylephrine.
[2] Ngan Kee WD, Lee SW, Ng FF, Tan PE, Khaw KS. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anaesthesia for caesarean delivery. Anesthesiology. 2015; 122(4):736-45.
[3] Ngan Kee WD. The use of vasopressors during spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol 2017; 30(3):319-25.
[4] Wang T, He Q, Zhang W, Zhu J, Ni H, Yang R, et al. Determination of the ED50 and ED95 of intravenous bolus of NE for the treatment of hypotension during spinal anaesthesia for cesarean delivery. Exp Ther Med. 2020; 19(3):1763-1770.
[5] Sharkey AM, Siddiqui N, Downey K, Ye XY, Guevara J, Carvalho JCA. Comparison of Intermittent Intravenous Boluses of Phenylephrine and Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean Deliveries: Randomized Controlled Trial. Anesth Analg. 2019; 129(5):1312-8.
[6] Mohta M, Dubey M, Malhotra RK, Tyagi A. Comparison of the potency of phenylephrine and NE bolus doses used to treat post-spinal hypotension during elective caesarean section. Int J Obstet Anesth. 2019; 38:25-31.
[7] Onwochei DN, Ngan Kee WD, Fung L, Downey K, Ye XY, Carvalho JCA. Norepinephrine Intermittent Intravenous Boluses to Prevent Hypotension During Spinal Anaesthesia for Cesarean Delivery: A Sequential Allocation Dose-Finding Study. Anesth Analg. 2017; 125(1):212-8.
[8] Ngan Kee WD. A Random-allocation Graded Dose-Response Study of Norepinephrine and Phenylephrine for Treating Hypotension during Spinal Anaesthesia for Cesarean Delivery. Anesthesiology. 2017; 127(6):934-41.
[9] Ngan Kee WD, Khaw KS, Tam YH, Ng FF, Lee SW. Performance of a closed-loop feedback computer-controlled infusion system for maintaining blood pressure during spinal anaesthesia for caesarean section: a randomized controlled comparison of norepinephrine versus phenylephrine. J Clin Monit Comput. 2017; 31(3):617-23.
[10] Jaitawat SS, Partani S, Sharma V, et al. Prophylactic administration of two different bolus doses of phenylephrine for prevention of spinal-induced hypotension during cesarean section: A prospective double-blinded clinical study. Journal of Obstetric Anaesthesia and Critical Care. 2019; 9:81-7.
| Files | ||
| Issue | Vol 8 No 1 (2022): Winter |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i1.8240 | |
| Keywords | ||
| Caesarean section hypotension norepinephrine phenylephrine spinal anaesthesia | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
