DOI: https://doi.org/10.53350/pjmhs22161967 ORIGINAL ARTICLE P J M H S Vol. 16, No.01, JAN 2022 967 A Comparative Study of Ephedrine and Phenylephrine in Averting Hypotension during Cesarean Section under Spinal Anesthesia SHAHID ADALAT CHAUDHRY 1 , MUBASHAR IQBAL 2 , MUHAMMAD NADEEM KHAN 3 , AUROOJ FATIMA 4 , HINA ZUBAIR 5 , MADIHA HAROON 6 1 Assistant Professor of Anesthesiology, Mohtarma Benazir Bhutto Shaheed Medical College and DHQ Teaching Hospital Mirpur, Azad Kashmir 2 Associate Professor of Anaesthesia, Mohi-ud-din Islamic Medical College and Mohi-ud-din Teaching Hospital Mirpur, Azad Kashmir 3 Associate Professor of Anaesthesia, Mohtarma Benazir Bhutto Shaheed Medical College and DHQ Teaching Hospital Mirpur Azad Kashmir 4 Associate professor, Gynae/Obs, Mohtarma Benazir Bhutto Shaheed Medical College Mirpur A.K 5 Associate Professor, Gynae/Obs, Mohtarma Benazir Bhutto Shaheed Medical College Mirpur A.K 6 Senior Registrar Gynae /Obs, Mohtarma Benazir Bhutto Shaheed Medical College Mirpur A.K Corresponding author: Dr. Shahid Adalat Chaudhry, Email: shahidadalat1971@gmail.com, Mob.0344-5163749 ABSTRACT Maternal haemodynamic variations are communal during caesarean section by spinal anesthesia. Several measures are adopted to treat hypotension. The aim of this study is to compare the effectiveness of phenylephrine and ephedrine in treating and preventing hypotension during C-section by spinal anesthesia and its outcome on the condition of the fetus. Place and Duration: In the Anesthesia department of Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six-months duration from July 2021 to December 2021. Methods: 120 total ASA grade-I patients with normal single pregnancy over 36 weeks who endured planned caesarean-section under spinal-anesthesia were randomized into 2 groups equally. Group I was given 5 mg rescue bolus and 10 mg prophylactic bolus dose of ephedrine intravenously during intrathecal block. Group II received 50 μg of rescue bolus and 100 μg of an intravenous dose of prophylactic phenylephrine bolus during intrathecal block. Haemodynamic variables such as heart rate and blood pressure were documented after every- 2-mints until birth and every 5-minutes thereafter. The neonatal score was measured using the 1- and 5-minute Apgar scale and the pH value of the neonatal blood in the umbilical cord. Results: There were no differences in the treatment of hypotension among the 2 groups. The bradycardia incidence was greater in the group of phenylephrine. The variances in Apgar score, birth weight and umbilical cord pH amid the 2 groups were not statistically significant. Conclusions: Ephedrine and phenylephrine are similarly operative in the treatment of hypotension during elective caesarean section given spinal anesthesia. No statical variance in the occurrence of true fetal acidosis between the two vasopressors was noticed. Both groups have good neonatal outcome. Key words: Fetal acidosis, ephedrine, phenylephrine, hypotension and spinal anesthesia. INTRODUCTION For C-section; Spinal anesthesia is extensively used and is safe and effective. The hypotension incidence during C- section under spinal anaesthesia was 82-91% or higher contingent on the used of definition 1-2 . In the case of the maternal signs, hypotension is particularly related with vomiting and nausea and severe cases have danger of pulmonary aspiration, reduced consciousness, cardiac arrest and respiratory depression 3-4 . May have harmful impacts on the new-born, including fetal acidosis, hypotension, impaired fetal oxygenation through asphyxia stress and decreased uteroplacental flow 5 . Since hypotension can be related with equally neonatal and maternal morbidity, numerous approaches have been considered, either singly or in grouping, for together treatment and prevention 6 . It is recognised that displacement of the uterine in left reduces the effects of aorto-caval-compression. Simply lifting the legs has little effect to decrease the hypotension incidence. Pre-hydration or pre-loading is common practice, but with debateable outcomes 7 . Due to the ineffectiveness of non pharmacological methods to efficiently control decreased blood pressure, often a vasopressor is vital during caesarean section under spinal anesthesia 8-9 . A number of factors should be considered in selecting the suitable vasopressor in gynae, including effectiveness in preserving BP, ease of use, maternal non-cardiovascular effects, indirect and direct impacts on the fetus, availability and cost 10 . Vasopressors commonly used during spinal anesthesia to prevent hypotension include metaraminol, phenylephrine and ephedrine 11 . The obstetric use of ephedrine in patients is reinforced by animal analysis showing that the blood flow to uteroplacental is well preserved when ephedrine is given to increase maternal BP 12 . Phenylephrine is a direct-acting alpha-agonist and potent. Relatively high doses of phenylephrine may be required during pregnancy due to the overall decrease in the response of pressor to exogenous and endogenous vasoconstrictors 15 . Though, no fetal acidosis was verified when there is widely use of phenylephrine to avert symptoms and preserve maternal BP 16 . The aim of this study is to compare the effectiveness of phenylephrine and ephedrine in treating and preventing hypotension during C- section by spinal anesthesia and its outcome on the condition of the fetus. MATERIALS AND METHODS This prospective double blind randomized controlled study held in the Anesthesia department of Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six- months duration from July 2021 to December 2021.