///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Does the addition of phenylephrine to prophylactic IV ephedrine further reduce the incidence of hypotension from intrathecal ropivacaine for C/S?

Abstract Number: 17
Abstract Type: Original Research

Maria Negron MD1 ; Shaul Cohen MD2; Achillina Rianto BS3; Barsoum Sylviana MD4; Purvi Patel MD5; Renu Chhokra MD6

Introduction: The use of prophylactic iv ephedrine is effective for prevention of hypotension from spinal anesthesia for cesarean section (C/S) when compared with lactated Ringers solution (LR) alone. This study was designed to determine whether the addition of phenylephrine to prophylactic IV ephedrine further reduces the incidence of hypotension from intrathecal ropivacaine for C/S.

Method: Following IRB approval & informed consent 96 parturients scheduled for elective C/S with CSE were studied. In all patients, the epidural space was located at L4-5 or L3-4 interspace using epidural needle in lateral decubitus position. The epidural catheter was inserted immediately following administration of 10 mg ropivacaine with 100 mcg epinephrine and 25 mcg fentanyl intrathecally. The patients were randomized into 4 groups: GI (n=35) received IV 2L LR prior to induction of spinal anesthesia. GII (n=31), received IV 1L LR & upon the spinal injection received IV ephedrine 30 mg for 15 min. GIII(n=30) received IV ephedrine 30mg for 15 min and IV phenylephrine 100 mcg.. Immediately after the spinal induction, the patients were positioned supine with left uterine displacement. BP was measured with automatic BP device every 2 min for the duration of the surgery. Hypotension was defined as a systolic BP (SBP) < 100 mm Hg & < 80% of the baseline BP. Hypotension was treated with IV ephedrine 5 mg every 2 min.

Results: GI(n=35) GII(n=31) GIII(n=30)

IV LR IV Eph IV Eph+Phenyl

Age (yrs) 324 316 316

Weight (lbs) 18434 17840 16937

Height (in) 6616 633 633

Primipara (%) 17(48) 15(48) 17(57)

Efficacy (n)

1(comfort.)(%) 33(94 ) 29( 94) 29 (97)

2(uncomfort.) 1(3 ) 1(3 ) 1(3)

Nausea (%) 15(43) 10(32) 13(43)

Nausea Rx(%) 10(29) 10(32) 8(27)

Vomiting(%) 3(9) 9(29) 16(53)*

Hypotension 16(46)** 4(13 ) 5(16.7)

Hypotension Rx 13(37 ) 6(19 ) 5(16.7)

(IV ephedrine boluses)

APGAR 1 min 8.30.8 8.50.7 8.70.6

APGAR 5min<7 3(9) 3(9.7) 3(10)

Overall Satisf. 9.70.6 9.80.5 9.60.9

*III>I, p<0.04, **I

Conclusion: The addition of phenylephrine to IV prophylactic ephedrine did not further reduce the incidence of hypotension from intrathecal ropivacaine for C/S. The IV administration of phenylephrine with ephedrine was associated with higher incidence of vomiting.

SOAP 2010