Comparison of Phenylephrine infusion vs Nor-epinephrine infusion on maternal hemodynamics and neonatal outcomes during Elective Lower Segment Caesarean Section under Sub-Arachnoid Block

Control of maternal hemodynamics during Caesarean section utilizing vasopressor infusion.

Abstract

Introduction:
Caesarean section is under Sub-Arachnoid block with a block level up-to T4 providing good surgical conditions. This block level is associated with sympathectomy which causes hypotension and placental hypoperfusion adversely affecting mother and neonate.

Objective:

This Single Blind Randomized Control Trial compared the efficacy of Phenylephrine and Nor-epinephrine IV infusions in maintaining maternal hemodynamics during EL-LSCS.

Methodology:

This study enrolled 62 patients fulfilling the inclusion criteria i.e., patient of age 18-45 years undergoing elective LSCS under SAB were enrolled in the study. While those having hypertension, pre-clampsia, eclampsia, pre-existing bradycardia, fetal distress and hypersensitivity to the medications used in the study were excluded. Enrolled patients were divided into two groups using computer generated random numbers with Group N patients received Nor-epinephrine infusion at rate of 2.5 Mcg/min while Group P patients received phenylephrine infusion at rate of 50 Mcg/min. Intraoperatively maternal hemodynamics were monitored and infusions were titrated to effect. Neonatal outcomes were assessed using APGAR score with umbilical cord ABGS carried out if clinically indicated.

Results:

Group P patients had statistically significant lower mean heart rate at 5,10,15 and 20 minutes as compared to group N. Similarly, pressures were significantly higher in group P than group N at 5,10,15,20 and 25 minutes. This required frequent changes in the rate of Phenylephrine infusion with the desired effect being achieved after 25 minutes of induction of Sub-Arachnoid block.

Conclusion:

Low dose Nor-Epinephrine infusion is safe and provides a better hemodynamic profile during Caesarean Section.