Effect of prophylactic phenylephrine and ephedrine added to the co-loading solution on maternal hypotension, nausea and vomiting in patients undergoing caesarean section in a remote Indian Island

Hypotension after spinal anaesthesia (SA) for a cesarean section may sometimes lead to significant consequences in mother and may also lead to a compromise in neonatal outcome. The objective of this study was to compare the effects of prophylactic Ephedrine and Phenylephrine to prevent hypotension, nausea, and vomiting, along with the possible changes in fetal outcome.After approval from the institute and with informed consent, 100 parturients undergoing cesarean section under SA, and who satisfied the inclusion criteria were divided into two groups. All patients received 10 mg of 0.5% Bupivacaine heavy for SA, and the drug was injected at the L3-4 level. All parturients were co-loaded with Ringer's lactate (RL), and either 100mcg Phenylephrine or 6mg Ephedrine was added in the RL solution. Occurrences of maternal hypotension, nausea, vomiting, and APGAR score for neonate were noted and compared.Phenylephrine group had a significant reduction in the incidence of hypotension. However, it did not translate into any significant reduction in the incidence of nausea or vomiting. There were also significant differences in the APGAR scores of the neonate in 1 and 10 minutes; Phenylephrine group had a better outcome as compared to Ephedrine group. Prophylactic Phenylephrine 100 mcg added to co-loading crystalloid prevents maternal hypotension significantly more than prophylactic Ephedrine 6 mg. The fetal outcome in terms of APGAR score was also better in the Phenylephrine group. However, there was no difference in the maternal heart rate, nausea, and vomiting among the groups.