Bolus Norepinephrine Versus Phenylephrine for the Management of Maternal Hypotension During Caesarean Delivery Under Spinal Anaesthesia -A Double Blind Randomized Controlled Trial

Abstract

Background: Spinal anaesthesia-induced hypotension is a frequent challenge during caesarean delivery and may compromise maternal comfort and uteroplacental perfusion. Phenylephrine is the standard vasopressor(1), while norepinephrine has emerged as a potential alternative because it may preserve heart rate better(2,3).

Methods: This prospective double-blind randomized study included 128 ASA II parturients undergoing elective caesarean delivery under spinal anaesthesia. Patients received intravenous norepinephrine 5 mcg or phenylephrine 50 mcg boluses when systolic blood pressure fell below 80% of baseline. Hemodynamic variables were recorded every minute until delivery. Neonatal APGAR scores and umbilical cord blood gas values were assessed(4).

Results: Both vasopressors effectively treated hypotension. Heart rate was lower in the norepinephrine group at selected time points (p<0.05), but clinically significant bradycardia was uncommon (3.13% vs 0%). Neonatal APGAR scores and cord blood gas values were comparable between groups(4).

Conclusion: Intermittent bolus norepinephrine and phenylephrine were both effective and safe for treatment of post-spinal hypotension during caesarean delivery. Norepinephrine showed a favorable hemodynamic profile with acceptable neonatal outcomes(2,5).