Comparison of prophylactic and therapeutic intermittent intravenous bolus doses of phenylephrine to treat spinal-induced hypotension in patient undergoing elective cesarean delivery at Shree Birendra Hospital, Chhauni

Abstract

Introduction: Spinal anesthesia is the preferred technique for elective cesarean delivery due to favorable maternal and fetal outcomes. However, spinal-induced hypotension is common and may cause maternal nausea, vomiting, and reduced uteroplacental perfusion, potentially affecting the fetus. Phenylephrine is widely used to prevent or treat this, but the optimal timing remains debated. This study compared prophylactic versus therapeutic intermittent intravenous bolus phenylephrine for maintaining maternal hemodynamic stability and evaluated maternal side effects and neonatal APGAR scores.

Method: This interventional study was conducted in the Department of Anaesthesiology Shree Birendra Hospital, Chhauni. Forty ASA II, non-laboring parturients over 18 years undergoing elective cesarean under spinal anesthesia were included. Patients were assigned to two groups (Group P and Group T) of 20 based on surgery day. All received spinal anesthesia with 10 mg of 0.5% hyperbaric bupivacaine at L3–L4 and Ringer’s lactate co-loading 10 ml/kg. Group P received phenylephrine 100 µg IV immediately after spinal block, while Group T received it only after hypotension (MAP <65 mmHg or >20% decrease). Maternal hemodynamics, side effects, and neonatal APGAR scores at 1 and 5 minutes were recorded. Rescue phenylephrine boluses were given as needed.

Result: Prophylactic phenylephrine maintained more stable maternal blood pressure, reduced hypotensive episodes, and required fewer rescue boluses. Nausea and vomiting were less frequent in the prophylactic group. Bradycardia, hypertension, and neonatal APGAR scores were comparable between groups.

Conclusion: Prophylactic intermittent IV phenylephrine is more effective than therapeutic dosing in preventing spinal-induced hypotension during elective cesarean delivery without affecting neonatal outcomes.