Current Trends in Biotechnology and Pharmacy

Phenylephrine is the first line choice for prevention and treatment of hypotension during a caesarean section under spinal anesthesia. However significant bradycardia caused by phenylephrine, is a concern. As a result, norepinephrine boluses have recently been proposed as an alternative to phenylephrine boluses. This study aim to compare the bolus doses of norepinephrine and phenylephrine to treat spinal hypotension during caesarean section and to compare the effects of phenylephrine and nor epinephrine on maternal heart rate, neonatal APGAR score and neonatal blood gas values. A randomized prospective double blinded study was conducted in 52 parturients of ASA 2 category, within age 20-40 years undergoing elective caesarean section under subarachnoid block. Parturients in group N received 4mcg of norepinephrine and group P receive 50mcg of phenylephrine. Blood pressure and heart rate was monitored every 2 min till 10 min, and thereafter every 5 min till the end of surgery. APGAR score at 1 and 5 min were assessed and foetal umbilical blood was sent for ABG analysis within 5 minutes of cord clamping. The results were analysed statistically using SPSS software. The number of bolus doses of vasopressors required to treat hypotension was significantly lower in N group (P< 0.01). The frequency of change in maternal heart rate from the baseline was more with phenylephrine compared to nor epinephrine. However, no significant bradycardia (HR<50) was noted in either group. The changes in maternal blood pressure and foetal parameters were comparable between the groups. There were no episodes of tachycardia or hypertension in both the groups. Norepinephrine boluses can be considered as an alternative to phenylephrine boluses for treating hypotension during caesarean section as it maintains the maternal hemodynamics and has a comparable effect on foetal parameters.