COMPARISON OF VARIABLE RATE PHENYLEPHRINE INFUSION WITH RESCUE PHENYLEPHRINE BOLUSES VERSUS RESCUE BOLUSES ALONE FOR PREVENTION OF HYPOTENSION DURING SPINAL ANESTHESIA FOR ELECTIVE CESAREAN DELIVERY

Abstract

Objective: To compare effectiveness of infusion with phenylephrine plus rescue boluses and rescue boluses in preventing frequency of maternal hypotension in patients undergoing cesarean section under spinal anesthesia.

Study Design: Quasi experimental study.

Place and Duration of Study: Anesthesia Department, Holy Family Hospital Rawalpindi, from Nov 2015 to May 2016.

Methodology: A total of 80 patients were randomly divided using lottery method in group A and B. Spinal anesthesia was given with co-loading as 15 ml/kg of ringer lactate, with 12mg of hyperbaric bupivacaine (0.75%). No pre-medication was used. Patients received variable amount phenylephrine infusion starting at 0.75μg/kg/ min (group A) or variable rate prophylactic saline infusion at 0.0075ml/kg/min (group B) (control group). Maternal hypotension was treated with rescue boluses of phenylephrine (50-100μg).

Results: Mean age was 30 ± 2.23years’ vs. 31± 2.81 years (group A Vs group B) (p=0.0818). The two groups did not differ in American society of Anaesthesiologists ASA status. Mean BMI in group A and group B was 24 ± 2.813 vs. 25 ± 3.114 (p=0.1358). Mean NIBP in group A and group B was 110/70mm Hg ± 8.62 vs. 111/80mm Hg ± 10.224 (p=0.6376). Phenylephrine infusion with rescue boluses was operational in 32 (80%) subjects (there was less incidence of maternal hypotension) compared to boluses only was efficacious in 14 (35%) of all patients p<0.001.

Conclusion: Our study concluded that phenylephrine infusion with rescue boluses provided better control of blood pressure than rescue boluses alone during cesarean section under spinal anesthesia.