A Comparison of Intravenous Ephedrine or Phenylephrine, for Prevention of Postspinal Hypotension during Elective Lower Abdominal Surgery: A Randomized, Double-blind Case–control Study

Abstract

Background:In this randomized, double-blinded case–control study, we investigated the intravenous effects of ephedrine or phenylephrine on prevention of post–spinal hypotension in elective lower abdominal surgery under spinal anesthesia.Materials and Methods:One hundred and thirty-five patients, American Society of Anesthesiologists physical status I or II candidate for elective lower abdominal surgery under spinal anesthesia were randomized to three groups (45 each). According to their allocated group, patients received either ephedrine 2.5 mg (E group), phenylephrine (P group) 25 mic as vasopressor or the same volume of saline normal as placebo (S group) immediately after the spinal anesthesia. hemodynamic parameters, and complications were recorded.Results:Patients’ demographics were similar in all the groups. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP and also heart rate were similar over time for groups E and P (P > 0.05). The incidence of reactive hypertension was more in group E than group P and placebo (P < 0.05). The incidence of nausea and vomiting were significantly lower in groups E and P in comparison with placebo (P < 0.05).Conclusion:Although the mean fall of SBP and DBP were significantly less in groups E and P compared with placebo but we did not find significant differences in prophylactic use of ephedrine or phenylephrine for prevention of post–spinal hypotension in elective lower abdominal surgery. Vasopressors infusion have added benefit of lower incidence of nausea and vomiting.

The Effect of Phenylephrine Infusion on Maternal Hemodynamic Changes During Spinal Anesthesia for Cesarean Delivery

“…Without preventive measures, such as fluid therapy, left uterine displacement and Trendelenburg position, hypotension following spinal anesthesia has reported in 80 to 95% of the patients (4,5), which may cause nausea, vomiting, dizziness, decreased level of consciousness, uterine perfusion, oxygenation of fetus, the increased in risk of aspiration in the mother, and fetal acidosis. In most cases, despite preservative measures, a vasopressor, such as phenylephrine or ephedrine is necessary (6,7). Recent studies have shown that by administering phenylephrine, a pure alphaadrenergic agonist, the mother's blood pressure is controlled better, nausea, and vomiting are less occurred, and Copyright © 2020, Author(s).…”