THE EFFECTIVENESS OF PROPHYLACTIC INTRAVENOUS PHENYLEPHRINE AND EPHEDRINE ON MATERNAL HEMODYNAMICS AND FETAL OUTCOME IN ELECTIVE CESAREAN SECTION UNDER SUBARACHNOID BLOCK

Dilip Kumar Bhowmick*, Pooja Bhari, Sharmin Ara Begum, Begum Maksuda Farida Akhtar, Akhtaruzzaman AKM

ABSTRACT

Objective: In this study our goal is to evaluate the effectiveness of prophylactic intravenous phenylephrine and ephedrine on maternal hemodynamics and fetal outcome in elective cesarean section under subarachnoid block. Method: This randomized Controlled trial (RCT) study was carried out at Obstetric Operation Theatre Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU for a period of 12 months. A total of 90 parturients admitted for elective caesarean section at Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical Universitywere included in the study, they were divided into two groups, 45 in each. Where Group P was the phenylephrine group and Group E was the ephedrine group. Results: During the study period, the mean arterial pressure was statistically significant at 3 minutes, 6 minutes, 9 minutes, 12 minutes before the delivery of the baby and at 20 minutes, 25 minutes, 30 minutes, 35 minutes, 40 minutes, 45 minutes after the delivery. But it was found to be statistically non significant at the baseline, 15 minutes before the delivery of the baby and at 5 minutes, 10 minutes, 15 minutes, 50 minutes after the delivery of the baby.Among all the 90 parturient, 3 parturient in group P and 8 parturient in group E developed hypotension and was subsequently treated with rescue doses of vasopressor. One parturient in group P and 2 parturient in group E developed dizziness. 1 (2.2%) parturient in group P and 8 (17.8%) parturient in group E developed nausea alone and 1(2.2%) parturient in group P and 5(11.1%) in group E had nausea with vomiting which was managed by ondansetron 4 mg. 3 (6.7%) out of 45 parturient in group P developed bradycardia which was managed by atropine 0.5mg .Out of 90 parturients 2(4.4%) parturient in group p and 8(17.8%) parturient developed tachycardia. Conclusion: From our study we can conclude that, prophylactic intravenous phenylephrine bolus at the given dose remarkably reduced the incidence of subarachnoid block induced hypotension with fewer adverse maternal effects. The use of phenylephrine was associated with better foetal acid base status, and satisfactory APGAR score.

Keywords: Phenylephrine, Subarachnoid block (SAB), anaesthetic technique.