Comparison of Norepinephrine with Ephedrine Boluses for the Treatment of Maternal Hypotension during Cesarean Section Under Spinal Anesthesia: A Prospective Observational Study

Abstract

Spinal Induced Hypotension: Hypotension is one of the most common side effects of spinal anesthesia for lower segment cesarean section (LSCS). The most commonly used vasopressors for the treatment of spinal-induced hypotension (SIH) are phenylephrine, ephedrine, and norepinephrine. Aim: This study aimed to compare the efficacy of boluses of ephedrine and norepinephrine for the treatment of SIH in cesarean section. Methods and Material: A prospective observational study was conducted on 160 women undergoing elective and emergency cesarean section receiving spinal anesthesia with injection of bupivacaine heavily. Whenever hypotension (fall in systolic blood pressure (SBP) <20% from baseline value or SBP <80 mm Hg, whichever is less) occurred, either ephedrine (6 mg) or noradrenaline (6 μg) was given intravenous (IV) bolus as per the availability. Primary outcomes were maternal hemodynamic parameters, number of episodes of hypotension, requirement of bolus vasopressors, and Apgar score. Other outcomes were episodes of tachycardia, bradycardia, hypertension, and maternal side effects such as nausea, vomiting, shivering, and arrhythmia. Data analysis was performed with the help of Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 25. A P- value of <0.05 was considered statistically significant. Results: The mean SBP of both groups was comparable (P < 0.05). The mean heart rate (HR) was significantly higher in group E than in group N at 8 minutes and after till 60 minutes (P < 0.001). No statistical difference was found between the two groups in the Apgar score (P > 0.05). The mean dose requirement of ephedrine in group E was 1.94 and in group N was 2.04. Conclusions: Ephedrine (6 mg) and norepinephrine (6 μg) boluses are efficacious in treating hypotension after spinal anesthesia in obstetric patients. Norepinephrine appears to be favorable in view of HR than ephedrine.