Comparison of Phenylephrine infusion vs Nor-epinephrine Infusion on Maternal Hemodynamics and Neonatal Outcomes During Elective Lower Segment Caesarean Section under Sub-Arachnoid Block

Objective: To compare the efficacy of Phenylephrine and Nor-epinephrine IV infusions in maintaining maternal hemodynamics during EL-LSCS. Methodology: This randomized control trial study was conducted department of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad from March, 2023 to November, 2023. This study enrolled 62 patients fulfilling the inclusion criteria i.e., patient of age 18-45 years undergoing elective LSCS under SAB were enrolled in the study. While those having hypertension, pre-clampsia, eclampsia, pre-existing bradycardia, fetal distress and hypersensitivity to the medications used in the study were excluded. Enrolled patients were divided into two groups using computer generated random numbers with Group N patients received Nor-epinephrine infusion at rate of 2.5 Mcg/min while Group P patients received phenylephrine infusion at rate of 50 Mcg/min. Intraoperatively maternal hemodynamics were monitored and infusions were titrated to effect. Neonatal outcomes were assessed using APGAR score with umbilical cord ABGS carried out if clinically indicated. Results: Group P patients had statistically significant lower mean heart rate at 5,10,15 and 20 minutes as compared to group N. Similarly, pressures were significantly higher in group P than group N at 5,10,15,20 and 25 minutes. This required frequent changes in the rate of Phenylephrine infusion with the desired effect being achieved after 25 minutes of induction of Sub-Arachnoid block. Conclusion: Low dose Nor-Epinephrine infusion is safe and provides a better hemodynamic profile during Caesarean Section.