Comparison of intravenous bolus phenylephrine, ephedrine and mephentermine for maintenance of arterial blood pressure during spinal anaesthesia in caesarean section

Sonika S, Shalini Y, Nebu CA, Manjunath HG, Priya L

Pdf Page Numbers :- 235-240

Sonika S¹, Shalini Y^2,*, Christine Ann Nebu³, Manjunath HG⁴ and Lakshmi Priya²

¹Department of Anaesthesiology, Janani Anaesthesia and Critical Care Services, Shivamogga, Karnataka 577201, India

²Department of Anaesthesiology, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India

³Department of Anaesthesiology, Sacred Heart Medical Center, Kottayam, Kerala 686001, India

⁴Department of Anaesthesiology, Chamarajanagar Institute of Medical sciences, Chamarajanagar, Karnataka 571313, India

*Corresponding author: Dr. Shalini Y, Senior Resident, Department of Anaesthesiology, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India. Email: shas0172@gmail.com

Received 24 April 2024; Revised 11 June 2024; Accepted 18 June 2024; Published 24 June 2024

Citation: Sonika S, Shalini Y, Nebu CA, Manjunath HG, Priya L. Comparison of intravenous bolus phenylephrine, ephedrine and mephentermine for maintenance of arterial blood pressure during spinal anaesthesia in caesarean section. J Med Sci Res. 2024; 12(3):235-240. DOI: http://dx.doi.org/10.17727/JMSR.2024/12-44

Copyright: © 2024 Sonika S et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Subarachnoid block, although being highly efficient, often has limitation such as hypotension which can result in adverse maternal and fetal outcome, continues to be a matter of concern to the Anesthesiologist. The study was to compare the effect of phenylephrine, ephedrine and mephentermine, for maintenance of arterial pressure during spinal anaesthesia for caesarean section.

Methodology: A prospective randomized double blinded study involving 90 patients with hypotension after subarachnoid block under spinal anesthesia was conducted, dividing them into three groups: P (Phenylephrine) 100 mcg, E (Ephedrine) 6 mg, and M (Mephentermine) 6 mg. Patients were compared based on age, weight, height, hemodynamic parameters, complications, and neonatal APGAR scores.

Results: On inter-group comparison rise in systolic, diastolic and mean arterial blood pressure at 1,2,4 and 6min after drug administration were significantly high in phenylephrine group (p <0.01) compared to ephedrine and mephentermine group. Thereafter the differences narrowed off. Heart rate was raised during episodes of hypotension. The mean heart rate was decreased significantly (p<0.05) in phenylephrine group compared to other two groups. The neonatal APGAR score were >/= 7 in the three groups at the 1st and 5th min.

Conclusion: The study found that phenylephrine, ephedrine, and mephentermine effectively maintained arterial blood pressure in intravenous bolus form during subarachnoid block for caesarean section. Phenylephrine, a fast-acting, short-lived normotensive drug, significantly reduced heart rate compared to ephedrine and mephentermine, but did not cause significant adverse effects on mother and fetus.

Keywords: hypotension; ephedrine; mephentermine; phenylephrine; subarachnoid block