Efficacy of Prophylactic Phenylephrine in Prevention of Hypotension in Parturient Undergoing Spinal Caesarean Section


  • Muhammad Salman Maqbool




Caesarean delivery, Hypotension, Phenylephrine, Spinal anaesthesia


To determine the hemodynamic (pulse, blood pressure) stability of prophylactic bolus dose of phenylephrine in caesarean
section under spinal anaesthesia.
Study design & Setting: Interventional study was done from 13th Feb 2021 to 07th Oct 2021 at Islam Teaching Hospital,
Methodology: Study approval was taken vide letter no.2021-05/AN dated 26-3-2021, issued by Chairman Ethical Review
Board, Islam Medical College, Sialkot. Statistical software(version. with (prob of 0.80, critical 2 value 15.08),
was employed and sample size calculated to be 200 cases i.e. groups-I (injection phenylephrine 100µgm) and group-II
(placebo) divided by lottery method into 100 each given at spinal neuraxial block. Primary study variable being heart rate
and blood pressure variations. Spearman’s Rank correlation statistical test was used to check interdependence between the
two variables i.e., systolic blood pressure and pulse rate. SPSS version 21 was used.
Results: In group-II, in 36% cases atropine was given as compared to 24% cases in group-I, thus 150 % more anti-cholinergic
was used in group-II. In group-II, in 33% cases top-up of injection Adrenaline 10 microgram was used whereas given in
24% cases in group-I, thus 137.5 % more top-ups of vasopressors in group-II. In group-I, heart rate decreased by value
of 9.02 % with respect to baseline value, while comparable reading noted was 3.42% decline in pulse rate in group-II
Conclusion: Prophylactic phenylephrine at time of spinal injection resulted in stable blood pressure and pulse rate values
in caesarean spinal delivery.


Iddrisu M, Khan ZH. Anesthesia for cesarean delivery:

general or regional anesthesia-a systematic review. AinShams J Anesthesiol 2021; 13:1. https://doi.org/10.


Bobet M, Joachim J, Gayat E, Bonnet A, Sievert K,

Barnichon C, Fischler M, Le Guen M. Blood pressure

measurement during cesarean delivery: Evaluation of

a beat-to-beat noninvasive device NexfinTM). Medicine

(Baltimore). 2021;100(22): e26129. doi:10.1097/

MD.0000 000000026129

Gousheh MR, Akhondzade R, Asl Aghahoseini H,

Olapour A, Rashidi M. The Effects of Pre-Spinal Anesthesia Administration of Crystalloid and Colloid Solutions on Hypotension in Elective Cesarean Section.

Anesth Pain Med 2018;8(4): e69446. doi:10.5812/


Ni HF, Liu HY, Zhang J, Peng K, Ji FH. Crystalloid

Coload Reduced the Incidence of Hypotension in Spinal

Anesthesia for Cesarean Delivery, When Compared to

Crystalloid Preload: A Meta-Analysis. Biomed Res Int.

; 2017:3462529. doi:10.1155/2017/3462529

Maqbool MS, Draz MU. Colloid preload and Coload

versus crystalloid preload in spinal cesarean delivery:

The effect of injection speed. Medical Forum Monthly.

; 28:102-105.

Chiang CF, Hasan MS, Tham SW, Sundaraj S, Faris A,

Ganason N. Injection speed of spinal anaesthesia for

Caesarean delivery in Asian women and the incidence

of hypotension: A randomised controlled trial. J Clin

Anesth. 2017; 39:82-86. doi: 10.1016/j.jclinane. 2017.03.

Hasanin A, Soryal R, Kaddah T, Raouf SA, Abdelwahab

Y, Elshafaei K, Elsayad M, Abdelhamid B, Fouad R,

Mahmoud D, Hassabelnaby Y. Hemodynamic effects

of lateral tilt before and after spinal anesthesia during

cesarean delivery: an observational study. BMC Anesthesiol. 2018;18(1):8. doi: 10.1186/s12871-018-0473-

Eskandr Ashraf M, Ahmed Ali M, Bahgat Eldin NM.

Comparative Study Among Ephedrine, Norepinephrine

and Phenylephrine Infusions to Prevent Spinal Hypotension During Cesarean Section. A Randomized Controlled

Double-Blind Study. Egypt J Anaesth 2021; 37:295-

doi: 10.1080/11101849.2021.1936841

Shitemaw T, Aregawi A, Fentie F, Jemal B. Prophylactic

ephedrine to prevent postspinal hypotension following

spinal anesthesia in elective cesarean section: A prospective cohort study in ethiopia. J Obstet Anaesth Crit

Care 2019; 9:75-80. DOI: 10.4103/joacc.JOACC_49_18

Abd Elraziq, B., Ali, S., Abotaleb, U., Alqassas, M.

Norepinephrine versus Ephedrine in Prevention of

Hypotension after Spinal Anesthesia. Al-Azhar Intern.

Med. J 2020; 1(10): 37-4. doi:10.21608/aimj. 2020.39


Nag DS, Samaddar DP, Chatterjee A, Kumar H, Dembla

A. Vasopressors in obstetric anesthesia: A current perspective. World J Clin Cases. 2015;3(1):58-64. doi: 10.

/ wjcc.v3.i1.58.

Practice Guidelines for Preoperative Fasting and the

Use of Pharmacologic Agents to Reduce the Risk of

Pulmonary Aspiration: Application to Healthy Patients

Undergoing Elective Procedures: An Updated Report

by the American Society of Anesthesiologists Task

Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology 2017; 126:376–393 doi: https://doi.org/10.1097/ALN.0000000000001452

Ferre F, Martin C, Bosch L, Kurrek M, Lairez O,

Minville V. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth. 2020; 13:39-


Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van

de Velde M, Vercueil A; Consensus Statement Collaborators. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia.

;73(1):71-92. doi: 10.1111/anae.14080.

Goel K, Luthra N, Goyal N, Grewal A, Taneja A.

Comparison of norepinephrine and phenylephrine

infusions for maintenance of haemodynamics following

subarachnoid block in lower segment caeserean section.

Indian J Anaesth. 2021; 65:600-605. doi: 10.4103/ ija.

IJA _185_21.

Shah PJ, Agrawal P, Beldar RK. Intravenous norepinephrine and mephentermine for maintenance of blood

pressure during spinal anaesthesia for caesarean section:

An interventional double-blinded randomized trial.

Indian J Anaesth. 2020; 64:235-241. doi: 10.4103/ ija.

IJA _91_20

Ferre F, Marty P, Bruneteau L, et al. Prophylactic

phenylephrine infusion for the prevention of hypotension

after spinal anesthesia in the elderly: a randomized

controlled clinical trial. J Clin Anesth 2016; 35:99–106.

doi: 10.1016/j.jclinane.2016.07.020

Doherty A, Ohashi Y, Downey K, Carvalho JCA. Phenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia: a double-blind

randomized clinical trial to assess hemodynamic changes.

Anesth Analg. 2012;115(6):1343–50. doi:10.1213/ANE.


Fakherpour A, Ghaem H, Fattahi Z, Zaree S. Maternal

and anaesthesia-related risk factors and incidence of

spinal anaesthesia-induced hypotension in elective

caesarean section: A multinomial logistic regression.

Indian J Anaesth. 2018;62(1):36-46. doi: 10.4103/ija.


T. Shitemaw, B. Jemal, T. Mamo, L. Akalu. Incidence

and associated factors for hypotension after spinal

anesthesia during cesarean section at Gandhi Memorial

Hospital Addis Ababa, Ethiopia PLoS One 2020;15 (8):

e0236755. PubMed PMID: 32790681.

Ngan Kee WD. The use of vasopressors during spinal

anaesthesia for caesarean section. Curr Open Anesthesiol

;30(3):319-25. doi:10.1097/ACO. 00000000000

Hasanin A, Mokhtar AM, Badawy AA, Fouad R. Postspinal anesthesia hypotension during caesarean delivery,

a review article. Egypt J Anaesth 2019; 33(2):189-93.

DOI: 10.1016/j.egja.2017.03.003

Imran M, Khan FH, Khan MA. Attenuation of hypotension using phenylephrine during induction of anaesthesia

with propofol. J Pak Med Assoc. 2007;57(11):543-7.

PMID: 18062519.

Khurana S, Kashmiri Z, Malik S, Riasat MI, Javaid H,

Sultan SF. Prevention of hemodynamic instability: A

comparative double blind study with phenylephrine on

patients with un-booked cesarean section. J Surg

Pakistan.2021;26(2):51-5. Doi:10.21699/jsp.26.2.3.

Maqbool MS, Shahid A, Shafqat H. To Evaluate and

Compare Clinical Effects of Varying Bolus Doses of

Oxytocin in Patients Undergoing Caesarean Spinal

Delivery. J Bahria Uni Med Dental Coll. 2020; 10(4):

-265. Doi: Org/10.51985/jbumdc2020018




How to Cite

Maqbool, M. S. . (2022). Efficacy of Prophylactic Phenylephrine in Prevention of Hypotension in Parturient Undergoing Spinal Caesarean Section. Journal of Bahria University Medical and Dental College, 12(02), 93–99. https://doi.org/10.51985/JBUMDC2021113



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