Prophylactic Ephedrine versus Phenylephrine for Prevention of Maternal Hypotension Following Spinal Anesthesia for Elective Cesarean Section: A Prospective Randomized Comparative Study

Abstract

Objective: To compare the efficacy of prophylactic intravenous bolus ephedrine and phenylephrine in preventing maternal hypotension following spinal anesthesia for elective cesarean section. Study Design: Prospective randomized comparative study. Place and Duration of Study: Department of Anesthesiology, Dow University of Health Sciences and Civil Hospital Karachi, from June to December 2023. Methodology: One hundred and sixty-six ASA physical status I–II parturients undergoing elective cesarean section under spinal anesthesia were randomly allocated to receive either ephedrine 10 mg IV (Group E, n=83) or phenylephrine 100 µg IV (Group P, n=83) as a prophylactic bolus administered three minutes prior to spinal anesthesia. Maternal hypotension was defined as a >20% reduction in mean arterial pressure (MAP) from baseline at any intraoperative time point. Data were analyzed using SPSS version 11. Results: Maternal hypotension occurred in 56 (67.5%) patients in Group E and 74 (89.2%) patients in Group P (p=0.001). Conclusion: In a bolus-based vasopressor protocol, prophylactic ephedrine was more effective than phenylephrine in preventing maternal hypotension following spinal anesthesia for elective cesarean section.