Comparison of norepinephrine and phenylephrine boluses for the treatment of hypotension during spinal anaesthesia for caesarean section – A randomised controlled trial

Abstract

Background and Aims:Hypotension following spinal anaesthesia for caesarean section is common in spite of adequate fluid loading. Phenylephrine is the recommended drug to treat spinal hypotension during caesarean section. Recently, norepinephrine boluses are being suggested as an alternative to phenylephrine boluses. The aim of our study was to compare the effectiveness of bolus doses of norepinephrine with phenylephrine to treat spinal hypotension during caesarean section.Methods:Fifty patients undergoing elective caesarean section under spinal anaesthesia were randomly assigned into two groups. Group P patients received phenylephrine 50 μg as an intravenous bolus and group N received 4 μg of norepinephrine as intravenous bolus to treat spinal hypotension. The primary objective of our study was to compare the number of bolus doses of norepinephrine or phenylephrine required to treat spinal hypotension. The secondary objectives were to compare the incidence of bradycardia, hypertension, nausea and vomiting in mother and foetal outcomes.Results:The number of boluses of vasopressors required to treat hypotension was significantly lower in group N (1.40 ± 0.577 vs. 2.28 ± 1.061, P = 0.001). The frequency of bradycardia was high in group P, but this difference was not statistically significant (4%vs. 20%, P = 0.192). Maternal complications such as nausea and vomiting and shivering were comparable between the groups. The foetal parameters were also comparable between the two groups.Conclusion:Intermittent boluses of norepinephrine are effective in the management of spinal-induced hypotension during caesarean section. The neonatal outcomes were similar in both the groups. Norepinephrine boluses can be considered as an alternative to phenylephrine boluses.

Intravenous norepinephrine and mephentermine for maintenance of blood pressure during spinal anaesthesia for caesarean section: An interventional double-blinded randomised trial

“…[ 1 3 9 10 11 ] Recent studies also showed a promising role of norepinephrine in SAIH for maintaining blood pressure with less negative effects on HR and cardiac output because of a potent α-agonist and a weak β-agonist property. [ 4 12 13 14 15 16 17 18 19 20 ]…”

The effect of ondansetron administration 20 minutes prior to spinal anaesthesia on haemodynamic status in patients undergoing elective caesarean section: A comparison between two different doses

“…But spinal anaesthesia has its own complications notably post spinal hypotension with or without bradycardia. [ 13 ] Hypotension after spinal block during caesarean section is common and the main treatment and prevention relies on IV fluids infusion and vasopressors administration such as phenylephrine, ephedrine, mephentermine. [ 14 ] Several studies have shown that ondansetron, which is basically an antiemetic drug, is beneficial in reducing incidence of hypotension which accompanies spinal block in caesarean section.…”

Spinal Ependymoma Identified Following Spinal Anesthesia for Cesarean Delivery

“…Neuraxial anesthesia is commonly performed for obstetric indications such as vaginal or cesarean delivery, tubal ligation, and cervical cerclage placement. Neuraxial anesthesia is generally safe, with common potential complications that include backache, post-dural puncture headache, and hypotension resulting in dizziness, nausea, and vomiting [ 1 ]. Rare complications include intraspinal hemorrhage, cauda equina syndrome, nerve injury, epidural abscess, and epidural hematoma, which may result in permanent nerve damage.…”