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ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 226-234

Comparison between prophylactic infusion of ephedrine and lower extremity compression in the prevention of postspinal hypotension during elective cesarean delivery


Anesthesia and Intensive Care Department, Minia University Hospital, Minia, Egypt

Correspondence Address:
Haidy S Mansour
Anesthesia and Intensive Care Department, Minia University Hospital, Minia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_81_16

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Background Hypotension during spinal block for cesarean section is secondary to the aortocaval compression by the uterus and sympathetic blockade and it can be deleterious to both the fetus and the mother. In this study, we compared the effect of leg wrapping, low-dose ephedrine infusion, and placebo on systolic blood pressure (SBP) during spinal block for cesarean section. Patients and methods In this randomized, double-blinded, placebo-controlled study, 90 American Society of Anesthesiology I and II women scheduled for elective cesarean section received either ephedrine (group E; n=29; initial bolus of 5 mg and infusion of 1.5 mg/min), leg wrapping (group L; n=30), or no treatment (group C; n=29). SBP and maximal decrease in SBP were the primary outcomes, and heart rate, neonatal acid–base status, Apgar score, and side effect as bradycardia, neausea, and vomiting were secondary outcome variables during the first 20 min after induction of spinal anesthesia. Results Fall in blood pressure in group C was more significant as compared with groups E and L (P<0.05). The incidence of hypotension was significantly lower in group C than in groups E and L (P=0.004 and 0.02, respectively). The incidence of bradycardia showed a significant difference between group E and both group L and group C (P=0.04 and 0.001, respectively). Nausea, vomiting, the umbilical blood gases, and Apgar scores in the first and fifth minute did not show significant differences between the three groups (P>0.05). Conclusion An initial bolus of ephedrine followed by a low-dose ephedrine infusion was superior to leg wrapping and no intervention for the prevention of hypotension during spinal anesthesia for cesarean delivery. Leg wrapping prevented hypotension compared with no intervention by limiting modest early spinal anesthesia-mediated venodilation.


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