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. 2023 Jan 23;15(1):e34118.
doi: 10.7759/cureus.34118. eCollection 2023 Jan.

A Randomized Controlled Trial Comparing the Effect of Phenylephrine by Intramuscular Route With Intravenous Infusion in Maintaining Haemodynamic Stability During Elective Lower Segment Caesarean Section Under Spinal Anaesthesia

Chandrekanth Lakshmikanthan  1 , Balasubramaniam Gayathri  1 , Swetha Ramani  1 , Natarajan Balasubramanian  1
Affiliations

A Randomized Controlled Trial Comparing the Effect of Phenylephrine by Intramuscular Route With Intravenous Infusion in Maintaining Haemodynamic Stability During Elective Lower Segment Caesarean Section Under Spinal Anaesthesia

Chandrekanth Lakshmikanthan et al. Cureus. .

Abstract

Background Hypotension is a commonly encountered side effect in patients undergoing spinal anaesthesia, particularly in patients undergoing caesarean section. Phenylephrine is a widely used drug to treat spinal-induced hypotension and to maintain hemodynamic stability. Our aim is to evaluate the effectiveness of phenylephrine given through two different routes prophylactically in prevention of post-spinal hypotension in patients undergoing caesarean section. Methods A total of 150 healthy pregnant women undergoing elective caesarean section were randomly allocated into three groups: Group M (prophylactic intramuscular use of 2 mg phenylephrine), group V (prophylactic intravenous infusion of 30 mcg phenylephrine per minute), and group P (no prophylaxis), rescue phenylephrine 30 mcg IV and atropine 0.6 mg IV were used intraoperatively to treat bradycardia and hypotension in all three groups. The primary outcome was maternal hemodynamic changes. Results There was an insignificant difference in demographic data between the groups. Maternal systolic and diastolic blood pressure were more stable in group M compared to group V and group P. Heart rate was significantly lower only in group V. We did not observe any statistical difference between the groups in the APGAR score or the fetal arterial blood gas values. The incidence of nausea and vomiting was more in group P. Conclusion Preventive intramuscular phenylephrine exhibited a more stable maternal hemodynamics when compared with the prophylactic intravenous infusion of phenylephrine and placebo in elective caesarean under spinal anaesthesia.

Keywords: caesarean section; hypotension; intramuscular; intravenous infusion; phenylephrine; spinal anaesthesia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CONSORT diagram
Figure 2
Figure 2. Distribution of HR
HR: Heart  rate, BPM: Beats/minute
Figure 3
Figure 3. Distribution of systolic blood pressure
SBP: Systolic Blood Pressure
Figure 4
Figure 4. Distribution of diastolic blood pressure
DBP: Diastolic Blood Pressure
See this image and copyright information in PMC

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