Abstract

EFFICACY OF A COMBINATION OF PREEMPTIVE PHENYLEPHRINE WITH CRYSTALLOID PRELOADING IN SPINAL ANAESTHESIA HYPOTENSION- A PROSPECTIVE, RANDOMISED, DOUBLE-BLIND STUDY

Author(s): Rekha Krishnankutty1, Vineetha Prabhakaran2

BACKGROUND
Hypotension is the most common adverse effect of spinal anaesthesia and contributes to increased perioperative morbidity. Experts differ in their opinion as to the most effective method of managing this complication. We evaluated the efficacy of combining prophylactic Intramuscular (IM) phenylephrine with crystalloid preloading as against crystalloid preloading alone to prevent or reduce the severity of hypotension in patients undergoing subarachnoid block for elective abdominal hysterectomy.
MATERIALS AND METHODS
In this prospective double-blind study, 60 patients undergoing elective abdominal hysterectomy were randomised into two equal groups (groups PP and PC). After preloading with 10mLkg-1 balanced salt solution, group PP received preemptive IM phenylephrine 3mg while group PC received 2 mL IM normal saline as placebo, both given immediately after induction of spinal anaesthesia. Baseline and perioperative systolic, diastolic, Mean Arterial Pressures (MAP) and Heart Rate (HR) were recorded and compared. The incidence of hypotension, total number of episodes of hypotension, the requirement of rescue vasopressor and occurrence of any adverse effects were also noted.
RESULTS
Data were analysed using Student’s unpaired t-test, Fischer’s test and ANOVA tests. Though the incidence of hypotension was comparable in both groups, the severity of hypotension as assessed by the total number of hypotensive episodes (P 0.009), the percentage reductions in MAP (P 0.013) and the mean dose requirement of ephedrine (p0.002) was significantly lower in group PP when compared to group PC.
CONCLUSION
Combining 3 mg prophylactic IM phenylephrine with crystalloid preloading is safe and effective in improving haemodynamic stability following spinal anaesthesia.