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Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus.
Rev Bras Anestesiol 2009 Jan-Feb; 59(1):11-20RB

Abstract

BACKGROUND AND OBJECTIVES

Hypotension during spinal block for cesarean section is secondary to the sympathetic blockade and aorto-caval compression by the uterus and it can be deleterious to both the fetus and the mother. Ephedrine and phenylephrine improve venous return after sympathetic blockade during the spinal block. The objective of this study was to compare the efficacy of ephedrine and phenylephrine in the prevention and treatment of maternal hypotension during spinal block and to evaluate their side effects and fetal changes.

METHODS

Sixty patients undergoing spinal block with bupivacaine and sufentanil for cesarean section were randomly divided in two groups to receive prophylactic ephedrine (Group E, n = 30, dose = 10 mg) or phenylephrine (Group P, n = 30, dose = 80 microg). Hypotension (blood pressure equal or lower than 80% of baseline values) was treated with bolus administration of the vasoconstrictor at 50% of the initial dose. The incidence of hypotension, reactive hypertension, bradycardia, and vomiting, and Apgar scores on the 1st and 5th minutes, and blood gases of the umbilical cord blood were evaluated.

RESULTS

The mean dose of ephedrine used was 14.8 +/- 3.8 mg and of phenylephrine was 186.7 +/- 52.9 microg. Demographic parameters and the incidence of vomiting, bradycardia, and reactive hypertension were similar in both groups. Hypotension had an incidence of 70% in Group E and 93% in Group P (p < 0.05). The mean arterial pH of the umbilical cord blood and the Apgar score in the 1st minute were lower in Group E (p < 0.05). Differences in the Apgar score in the 5th minute were not observed.

CONCLUSIONS

Ephedrine was more effective than phenylephrine in the prevention of hypotension. Both drugs had similar incidence of side effects. Fetal repercussions were less frequent with phenylephrine and were transitory with the use of ephedrine.

Authors+Show Affiliations

CET/SBA do Centro de Anestesiologia do Hospital Universitário de Brasilia, Universidade de Brasilia (UnB), Brasilia, DF. ednomag@gmail.com

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng por

PubMed ID

19374211

Citation

Magalhães, Edno, et al. "Ephedrine Versus Phenylephrine: Prevention of Hypotension During Spinal Block for Cesarean Section and Effects On the Fetus." Revista Brasileira De Anestesiologia, vol. 59, no. 1, 2009, pp. 11-20.
Magalhães E, Govêia CS, de Araújo Ladeira LC, et al. Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus. Rev Bras Anestesiol. 2009;59(1):11-20.
Magalhães, E., Govêia, C. S., de Araújo Ladeira, L. C., Nascimento, B. G., & Kluthcouski, S. M. (2009). Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus. Revista Brasileira De Anestesiologia, 59(1), pp. 11-20.
Magalhães E, et al. Ephedrine Versus Phenylephrine: Prevention of Hypotension During Spinal Block for Cesarean Section and Effects On the Fetus. Rev Bras Anestesiol. 2009;59(1):11-20. PubMed PMID: 19374211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus. AU - Magalhães,Edno, AU - Govêia,Catia Sousa, AU - de Araújo Ladeira,Luís Cláudio, AU - Nascimento,Bruno Góis, AU - Kluthcouski,Sérgio Murilo Cavalcante, PY - 2009/4/21/entrez PY - 2009/4/21/pubmed PY - 2009/6/23/medline SP - 11 EP - 20 JF - Revista brasileira de anestesiologia JO - Rev Bras Anestesiol VL - 59 IS - 1 N2 - BACKGROUND AND OBJECTIVES: Hypotension during spinal block for cesarean section is secondary to the sympathetic blockade and aorto-caval compression by the uterus and it can be deleterious to both the fetus and the mother. Ephedrine and phenylephrine improve venous return after sympathetic blockade during the spinal block. The objective of this study was to compare the efficacy of ephedrine and phenylephrine in the prevention and treatment of maternal hypotension during spinal block and to evaluate their side effects and fetal changes. METHODS: Sixty patients undergoing spinal block with bupivacaine and sufentanil for cesarean section were randomly divided in two groups to receive prophylactic ephedrine (Group E, n = 30, dose = 10 mg) or phenylephrine (Group P, n = 30, dose = 80 microg). Hypotension (blood pressure equal or lower than 80% of baseline values) was treated with bolus administration of the vasoconstrictor at 50% of the initial dose. The incidence of hypotension, reactive hypertension, bradycardia, and vomiting, and Apgar scores on the 1st and 5th minutes, and blood gases of the umbilical cord blood were evaluated. RESULTS: The mean dose of ephedrine used was 14.8 +/- 3.8 mg and of phenylephrine was 186.7 +/- 52.9 microg. Demographic parameters and the incidence of vomiting, bradycardia, and reactive hypertension were similar in both groups. Hypotension had an incidence of 70% in Group E and 93% in Group P (p < 0.05). The mean arterial pH of the umbilical cord blood and the Apgar score in the 1st minute were lower in Group E (p < 0.05). Differences in the Apgar score in the 5th minute were not observed. CONCLUSIONS: Ephedrine was more effective than phenylephrine in the prevention of hypotension. Both drugs had similar incidence of side effects. Fetal repercussions were less frequent with phenylephrine and were transitory with the use of ephedrine. SN - 0034-7094 UR - https://www.unboundmedicine.com/medline/citation/19374211/Ephedrine_versus_phenylephrine:_prevention_of_hypotension_during_spinal_block_for_cesarean_section_and_effects_on_the_fetus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0034-70942009000100003 DB - PRIME DP - Unbound Medicine ER -