Comparison of infusions of Phenylephrine, Norepinephrine, and Mephentermine on Maternal hemodynamics and Neonatal outcomes in Caesarean Section under Spinal Anaesthesia

Amit Pradhan, Rasulata Swain, Priyadarsini Samanta, Laxman K Senapati, Ganesh C Satapathy

Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India

Refer this article

Amit Pradhan, Rasulata Swain, Priyadarsini Samanta, Laxman K Senapati, Ganesh C Satapathy, 2024. Comparison of infusions of phenylephrine, norepinephrine, and Mephentermine on maternal hemodynamics and neonatal outcomes in caesarean section under spinal anaesthesia. . Journal of medical pharmaceutical and allied sciences, V 13 - I 1, Pages- 6392 – 6400. Doi: https://doi.org/10.55522/jmpas.V13I1.5919.

ABSTRACT

Although the subarachnoid block is the preferred anesthetic technique for the caesarean section, on the downside it is often associated with complications like maternal hypotension. We compared phenylephrine, norepinephrine, and mephentermine infusions to maintain blood pressure during the caesarian section under subarachnoid block. Our study included 240 parturients with singleton-term pregnancies undergoing a caesarian section under spinal anesthesia. Following spinal anesthesia till the delivery of the baby, parturients randomly assigned to three groups received phenylephrine, norepinephrine, and mephentermine infusions. Heart rate, blood pressure, intra-operative nausea and vomiting, neonatal Apgar score, and total rescue vasopressors required were analyzed. Except at 4 min (p=0.006), ANOVA revealed no statistically significant difference in systolic blood pressure between the groups across all time points. Systolic blood pressure showed a significant difference between the mephentermine group versus the phenylephrine group (p=0.013) and the norepinephrine group versus the phenylephrine group (p=0.022) at four minutes post hoc Bonferroni. Except at 15 and 60 minutes (p=0.02 and p=0.001, respectively), the mean heart rate was comparable among the three groups. The Chi-square test revealed no statistically significant difference in the requirement of rescue drugs among the groups (ϰ2=1.57, p=0.45) except at the time point of 4 minutes (p=0.01) when the highest requirement was observed in the phenylephrine group. The Apgar scores amongst the groups were comparable at 1 min (p=0.99) and 5 min (p=0.98). In the lower segment caesarian section under the subarachnoid block, infusions of phenylephrine, norepinephrine, and mephentermine were equally effective in managing maternal hypotension and achieving favorable neonatal outcomes.

Keywords:

Phenylephrine, Norepinephrine, Mephentermine, LSCS, Hypotension APGAR Score.

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