Comparative Study Among Ephedrine, Norepinephrine and Phenylephrine Infusions to Prevent Spinal Hypotension During Cesarean Section. A Randomized Controlled Double-Blind Study

Figures & data

Figure 1. Flow diagram of the study

Table 1. Comparison between studied groups as regards demographic data

	Group P (n = 25)	Group N (n = 25)	Group E (n = 25)	One-way ANOVA
	Mean±SD	Mean±SD	Mean±SD	F	P-value
Age (yr)	27.64 ± 4.00	27.40 ± 3.71	28.04 ± 5.35	0.134	0.875
Weight (kg)	77.16 ± 6.39	77.36 ± 6.92	81.52 ± 8.91	2.701	0.074
BMI	28.02 ± 2.31	28.07 ± 2.58	31.07 ± 3.79	8.718	0.061
Time of surgery (min)	46.40 ± 4.9	43.8 ± 6	43.2 ± 5.18	2.499	0.089
Number of interventions (boluses) Phenylephrine (0.2 µg/kg) Norepinephrine(0.1µg/kg) Ephedrine(5 mg)	2	2	4	0.230	0.891

Table 2. Comparison between studied groups as regards maternal heart rate

	Group P (n = 25)	Group N (n = 25)	Group E (n = 25)	One-way ANOVA
	Mean±SD	Mean±SD	Mean±SD	F	P-value
Before anesthesia	88.36 ± 3.96	91.04 ± 8.65	91.28 ± 8.13	1.26	0.29
After 5 min	79.72 ± 5.00^#	87.32 ± 9.01^†	94.6 ± 9.45^‡	21.24	0.001*
10 min	76.48 ± 7.85^#	83.44 ± 10.56^†	94.24 ± 10.43^‡	21.3	0.001*
15 min	75.96 ± 5.39^#	80.20 ± 11.18	87.32 ± 10.42^‡	9.41	0.001*
20 min	73.76 ± 3.41^#	79.4 ± 8.58^†	88.96 ± 12.03^‡	19.26	0.001*
25 min	70.36 ± 7.74^#	76.12 ± 7.85^+	88.64 ± 13.00^‡	22.55	0.001*
30 min	71.24 ± 6.64^#	71.88 ± 9.3	87.76 ± 13.52^‡	20.96	0.001*
35 min	66.64 ± 5.44^#	73.84 ± 5.85^†	88.00 ± 11.91^‡	43.07	0.001*
40 min	67.12 ± 5.67^#	74.64 ± 7.34^†	85.96 ± 6.00^‡	55.28	0.001*
45 min	67.12 ± 5.54^#	74.88 ± 5.29^†	88.00 ± 7.86^‡	69.35	0.001*
50 min	67.52 ± 2.87^#	74.12 ± 5.41^†	88.64 ± 6.82^‡	104.21	0.001*
55 min	68.32 ± 3.7^#	74.32 ± 4.67^†	89.44 ± 5.55^‡	133.98	0.001*

* significance between the groups P-value<0.05. ^† significance between group N and group P, ^‡ significance between group E and group N, ^# significance between group P and group E.

Table 3. Comparison between studied groups as regards maternal mean blood pressure

	Group P (n = 25)	Group N (n = 25)	Group E (n = 25)	One way ANOVA
	Mean±SD	Mean±SD	Mean±SD	F	P value
Before anesthesia	78.72 ± 5.8	75.48 ± 5.54	77.04 ± 5.14	2.17	0.122
After 5 min	69.24 ± 4.03^†	64.04 ± 5.53^#	67.4 ± 4.06	8.24	0.001*
10 min	67.8 ± 4.85^†	64.4 ± 4.15	66.88 ± 4.06^‡	4.05	0.021*
15 min	70.24 ± 5.1^†	66.8 ± 3.21	69.44 ± 3.9^‡	4.72	0.012*
20 min	70.52 ± 4.1	71.0 ± 3.81^#	73.88 ± 3.71^‡	5.49	0.006*
25 min	71.28 ± 4.56	72.32 ± 3.5	74.4 ± 3.59^‡	4.12	0.02*
30 min	75.36 ± 4.06^†	70.48 ± 3.68^#	81.32 ± 3.52^‡	52.11	0.001*
35 min	74.4 ± 3.06^†	66.61 ± 4.14^#	81.96 ± 3.51^‡	113.8	0.001*
40 min	76.6 ± 3.67^†	70.64 ± 3.33^#	81.56 ± 4.26^‡	52.5	0.001*
45 min	76 ± 3.49	74.28 ± 3.82^#	81.52 ± 4.58^‡	22.47	0.001*
50 min	77.08 ± 3.4^†	74.24 ± 3.81^#	81.76 ± 4.43^‡	23.66	0.001*
55 min	78 ± 4.24^†	75.4 ± 4.5^#	82.32 ± 4.37^‡	15.99	0.001*

* significance between the groups P value<0.05. ^† significance between group P and group N, ^‡ significance between group P and group E, ^# significance between group N and group E.

Table 4. Comparison between studied groups as regards Neonatal outcome

	Group P (n = 25)	Group N (n = 25)	Group E (n = 25)	F	P-value
Apgar score at the first minute	9 (8–10)	9 (7–10)	8 (7–10)	H = 0.424	0.809
Apgar score after 5 min	9 (9–10)	9 (8–10)	9 (7–10)	H = 0.249	0.883
pH	7.38 ± 0.03	7.37 ± 0.03^#	7.33 ± 0.07^‡	7.84	0.001*
Fetal acidosis	0(0)	0(0)	2(8)	Χ^2=4.11	0.128
PO2	27.47 ± 2.15^†	25.94 ± 3.07	25.2 ± 2.7^‡	4.71	0.012*
PCO2	38.5 ± 2.94	39.6 ± 3.4	39.2 ± 6.74	0.35	0.703
HCO3	23.88 ± 1.34	23.15 ± 0.76	22.81 ± 1.66^‡	4.37	0.016*

* significance between the groups P value<0.05. ^† significance between group P and group N, ^‡ significance between group P and group E, ^# significance between group N and group E.

Table 5. Comparison between studied groups as regards maternal complications

	Group P (n = 25)		Group N (n = 25)		Group E (n = 25)		Chi square test
	n	%	n	%	n	%	X^2	P value
Nausea	2	8.0%	0	0.0%	2	8.0%	2.113	0.348
Vomiting	1	4.0%	0	0.0%	2	8.0%	2.083	0.353
Metoclopramide	3	12.0%	0	0.0%	4	16.0%	4.097	0.129
Hypertension	0	0.0%	0	0.0%	2	8.0%	4.11	0.128
Tachycardia	0	0.0%	0	0.0%	3	12.0%	6.25	0.044*
Bradycardia	4	16.0%	2	8.0%	0	0.0%	4.348	0.114

* significance between the groups P-value<0.05.

Table A1 Apgar Score

	0	1	2
Color	Blue or pale all over	Blue at extremities body pink (Acrocyanosis)	No cyanosis body and extremities pink
Pulse rate	Absent	<100	≥100
Reflex	No response to stimulation	Grimace/feeble cry when stimulated	Cry or pull away when stimulated
Muscle tone	Flaccid	Some flexion	Flexed arms and legs that resist extension
Breathing	Apneic	Weak, irregular, gasping	Regular, lusty cry