Prophylactic phenylephrine - ephedrine combination therapy for maternal hypotension during spinal anaesthesia: comparative study

ABSTRACT

The study was designed to evaluate the efficacy of three different regimens for prophylactic treatment of hypotension during spinal anaesthesia for elective cesarean section. Thirty-six parturients, 21-32 years old, ASA I or II and term singleton pregnancy were randomized to one of three groups receiving, preload 1.5 L Ringer's lactate solution [Fluid group] [F group], ephedrine I.V infusion 2 mg/min. [Ephedrine group] [E group], or I.V infusion 2 mg/min ephedrine plus 10 micro g/min. phenylephrine [Ephedrine + phenylephrine group [E + P group]. Maternal systolic blood pressure and heart rate were measured at frequent intervals. Hypotension defined as systolic blood pressure decrease >/= 20% from baseline blood pressure. We found that hypotension occurred less frequently in [E + P] group than in [F or E] groups 35% versus 73% and 77% respectively, supplemental ephedrine requirement and nausea scores [0 - 3] were less in the [E + P] group. Neonatal venous and arterial pH values were significantly higher in [E + P] group. Apgar scores were similarly good in the three groups. On conclusion, the incidence of hypotension during spinal anaesthesia for elective caesarean section delivery was significantly lower in phenylephrine ephedrine combination than in ephedrine infusion alone or crystalloid preload