A Comparative Study of Phenylephrine Hydrochloride and Ephedrine Hydrochloride for Treating Post-Spinal Hypotension in Lower Abdominal Surgeries
Keywords:
Post-spinal hypotension, phenylephrine hydrochloride, ephedrine hydrochloride, spinal anesthesia, lower abdominal surgeryAbstract
Background: Post-spinal hypotension is a common complication during lower abdominal surgeries under spinal anesthesia. This study compares the efficacy of phenylephrine hydrochloride and ephedrine hydrochloride in treating post-spinal hypotension.
Methods: Eighty patients aged 25–45 years with ASA physical status I or II, scheduled for elective lower abdominal surgeries under spinal anesthesia, were randomized into two groups. Group P received 100 µg intravenous phenylephrine, and Group E received 6 mg intravenous ephedrine upon a 30% drop in systolic blood pressure (SBP) from baseline. Hemodynamic parameters were recorded at specific intervals intraoperatively and postoperatively.
Results: Phenylephrine restored SBP more rapidly than ephedrine (p<0.001). However, phenylephrine was associated with significant bradycardia compared to ephedrine (p<0.001). Side effects such as headache and bradycardia were more prevalent in the phenylephrine group, whereas nausea and vomiting were more common in the ephedrine group.
Conclusion: Both phenylephrine and ephedrine are effective in managing post-spinal hypotension. Phenylephrine restores blood pressure more rapidly but has a higher incidence of bradycardia. Ephedrine maintains heart rate better but is less effective in rapidly increasing blood pressure.
Downloads
Metrics
References
M. Choudhary and J.K. "Study comparing phenylephrine bolus versus infusion for maternal hypotension and neonatal outcome during cesarean section under spinal anesthesia." Anesth Essays Res. 2018 Apr-Jun; 12(2): 446-451. doi: 10.4103/aer.AER_23_18. PMID: 29962614; PMCID: PMC6020566.
Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A; Collaborators Declaration of Conformity. "International consensus statement on the treatment of hypotension with vasopressors during cesarean section under spinal anesthesia." Anesthesia. 2018 Jan;73(1):71-92. doi: 10.1111/anae.14080. Epub 2017 Nov 1. PMID: 29090733.
Rajanalini, R.Kanyakumari. "Efficacy of vasopressors in the treatment of hypotension during spinal anesthesia." Indian Journal Of Applied Research 2017;7(8):368-370.
S Dusitkasem, Herndon BH, Somjit M, Stahl DL, Bitticker E, and Coffman JC. "Comparison of Phenylephrine and Ephedrine in treatment of spinal-induced hypotension in High-risk Pregnancies: A Narrative Review." Front. Copper. 4:2. doi:10.3389/fmed.2017.00002.
Mwaura L, Mung'ayi V, Kabugi J, Mir S. "Randomized controlled trial comparing weight-adjusted dose versus fixed dose of prophylactic phenylephrine infusion to maintain systolic blood pressure during cesarean section under spinal anesthesia." Afr Health Sci. 2016 Jun; 16(2): 399-411. doi: 10.4314/ahs.v16i2.8. PMID: 27605955; PMCID: PMC4994557.
Mudiganti RKR, Rajkumar J, Subhash AT. "Comparison of bolus intravenous ephedrine and phenylephrine for maintenance of arterial blood pressure in caesarean section during spinal anaesthesia." J. Evid. Based Med. Healthc. 2016; 3(19), 792-797. DOI: 10.18410/jebmh/2016/180.
Fauzia Shifaat, Sheikh Imran Syed, Sudershan Gupta, Qazi Danish, Hilal Ahmad Wani. "Comparison of Ephedrine, Mephentermine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anaesthesia." Int J Med Res Prof. 2016, 2(2); 51-58.
Mohta, M., Aggarwal, M., Sethi, A.K., Harisinghani, P., Guleria, K. "Randomized double-blind comparison of ephedrine and phenylephrine for management of postspinal hypotension in potential fetal compromise." International Journal of Obstetric Anesthesia (2016), doi: http://dx.doi.org/10.1016/j.ijoa.2016.02.004.
Moradi Farsani D, Naghibi Kh, Alikiaei B, Mashayekhi Z. "Comparison of the effects of intravenous phenylephrine and ephedrine in the treatment of hypotension after spinal anesthesia in orthopedic surgery." J Babol Univ Med Sci.2016;18(6):21-7.
Moslemi F, Rasooli S. "Comparison of Prophylactic Infusion of Phenylephrine with Ephedrine for Prevention of Hypotension in Elective Cesarean Section under Spinal Anesthesi: A Randomized Clinical Trial." Iran J Med Sci.
Bhardwaj N, Jain K, Arora S, Bharti N. "A comparison of three vasopressors for tight control of maternal blood pressure during cesarean section under spinal anesthesia: Effect on maternal and fetal outcome." J Anaesthesiol Clin Pharmacol. 2013 Jan;29(1):26-31. doi: 10.4103/0970-9185.105789. PMID: 23492921; PMCID: PMC3590536.
Simin, A., Zahra, F., Pouya, H. and Reza, T. "Comparison of the effect of ephedrine and phenylephrine in the treatment of hypotension after spinal anesthesia during caesarean section." Open Journal of Obstetrics and Gynecology, 2012;2, 192-196. doi: 10.4236/ojog.2012.23038.
Heesen M., Veeser M., Hofmann T., Roth R., Klöhr S., Rossaint R. "Vasopressors for the treatment of hypotension after spinal anesthesia for elective caesarean section: A systematic review and cumulative meta-analysis." Acta Anaesthesiol Scand. 2012 Aug;56(7):810-6. doi: 10.1111/j.1399-6576.2011.02646.x. Epub 2012 Feb 7. Erratum in: Acta Anaesthesiol Scand. 2012 Oct;56(9):1204. PMID: 22313496.
Dyer RA, Biccard BM. "The final nail in the coffin: ephedrine for spinal hypotension during elective caesarean section?" Acta Anaesthesiol Scand. 2012 Aug;56(7):807-9. doi: 10.1111/j.1399-6576.2012.02719.x. PMID: 22780437.
.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
