A Comparison of Intravenous Ephedrine or Phenylephrine, for Prevention of Postspinal Hypotension during Elective Lower Abdominal Surgery: A Randomized, Double-blind Case–control Study

Document Type : Original Article


1 Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan, Iran

2 Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran


Background: In this randomized, double-blinded case–control study, we investigated the intravenous effects of ephedrine or phenylephrine on prevention of post–spinal hypotension in elective lower abdominal surgery under spinal anesthesia. Materials and Methods: One hundred and thirty-five patients, American Society of Anesthesiologists physical status I or II candidate for elective lower abdominal surgery under spinal anesthesia were randomized to three groups (45 each). According to their allocated group, patients received either ephedrine 2.5 mg (E group), phenylephrine (P group) 25 mic as vasopressor or the same volume of saline normal as placebo (S group) immediately after the spinal anesthesia. hemodynamic parameters, and complications were recorded. Results: Patients' demographics were similar in all the groups. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP and also heart rate were similar over time for groups E and P (P > 0.05). The incidence of reactive hypertension was more in group E than group P and placebo (P < 0.05). The incidence of nausea and vomiting were significantly lower in groups E and P in comparison with placebo (P < 0.05). Conclusion: Although the mean fall of SBP and DBP were significantly less in groups E and P compared with placebo but we did not find significant differences in prophylactic use of ephedrine or phenylephrine for prevention of post–spinal hypotension in elective lower abdominal surgery. Vasopressors infusion have added benefit of lower incidence of nausea and vomiting.


Das S, Mukhopadhyay S, Mandal M, Mandal S, Basu SR. A comparative study of infusions of phenylephrine, ephedrine and phenylephrine plus ephedrine on maternal haemodynamics in elective caesarean section. Indian J Anaesth 2011;55:578-83.  Back to cited text no. 1
[PUBMED]  [Full text]  
Saravanan S, Kocarev M, Wilson RC, Watkins E, Columb MO, Lyons G. Equivalent dose of ephedrine and phenylephrine in the prevention of post-spinal hypotension in Caesarean section. Br J Anaesth 2006;96:95-9.  Back to cited text no. 2
Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg 2010;111:1230-7.  Back to cited text no. 3
Ansari T, Hashem MM, Hassan AA, Gamassy A, Saleh A. Comparison between two phenylephrine infusion rates with moderate co-loading for the prevention of spinal anaeshtesia-induced hypotension during elective caesarean section. Middle East J Anesthesiol 2011;21:361-6.  Back to cited text no. 4
Loubert C. Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing professional development. Can J Anaesth 2012;59:604-19.  Back to cited text no. 5
Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg 2012;114:377-90.  Back to cited text no. 6
Jabalameli M, Safavi M, Honarmand A, Saryazdi H, Moradi D, Kashefi P. The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res 2012;1:53.  Back to cited text no. 7
[PUBMED]  [Full text]  
Khalili G, Janghorbani M, Saryazdi H, Emaminejad A. Effect of preemptive and preventive acetaminophen on postoperative pain score: A randomized, double-blind trial of patients undergoing lower extremity surgery. J Clin Anesth 2013;25:188-92.  Back to cited text no. 8
Khalili G, Janghorbani M, Sajedi P, Ahmadi G. Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: A randomized, double-blind trial in patients undergoing lower extremity surgery. J Anesth 2011;25:892-7.  Back to cited text no. 9
Yoon HJ, Cho HJ, Lee IH, Jee YS, Kim SM. Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery. Korean J Anesthesiol 2012;62:35-9.  Back to cited text no. 10
Park YH, Ryu T, Hong SW, Kwak KH, Kim SO. The effect of the intravenous phenylephrine on the level of spinal anesthesia. Korean J Anesthesiol 2011;61:372-6.  Back to cited text no. 11
Bhardwaj N, Jain K, Arora S, Bharti N. A comparison of three vasopressors for tight control of maternal blood pressure during cesarean section under spinal anesthesia: Effect on maternal and fetal outcome. J Anaesthesiol Clin Pharmacol 2013;29:26-31.  Back to cited text no. 12
[PUBMED]  [Full text]  
Gunda CP, Malinowski J, Tegginmath A, Suryanarayana VG, Chandra SB. Vasopressor choice for hypotension in elective Cesarean section: Ephedrine or phenylephrine? Arch Med Sci 2010;6:257-63.  Back to cited text no. 13
Kol IO, Kaygusuz K, Gursoy S, Cetin A, Kahramanoglu Z, Ozkan F, et al. The effects of intravenous ephedrine during spinal anesthesia for cesarean delivery: A randomized controlled trial. J Korean Med Sci 2009;24:883-8.  Back to cited text no. 14
Jabalameli M, Soltani HA, Hashemi J, Behdad S, Soleimani B. Prevention of post-spinal hypotension using crystalloid, colloid and ephedrine with three different combinations: A double blind randomized study. Adv Biomed Res 2012;1:36.  Back to cited text no. 15
[PUBMED]  [Full text]  
Shim KS, Kim EJ, Lee JH, Lee SG, Ban JS, Min BW. Combined spinal-epidural anesthesia for cesarean section in a patient with Moyamoya disease -A case report-. Korean J Anesthesiol 2010;59(Suppl):S150-3.  Back to cited text no. 16
Acar NS, Uzman S, Toptas M, Vahapoglu A, Akkoc I, Dinc SC. Spinal anesthesia with hyperbaric bupivacaine: A comparison of hypertensive and normotensive patients. Med Sci Monit 2013;19:1109-13.  Back to cited text no. 17
Kweon TD, Kim SY, Cho SA, Kim JH, Kang YR, Shin YS. Heart rate variability as a predictor of hypotension after spinal anesthesia in hypertensive patients. Korean J Anesthesiol 2013;65:317-21.  Back to cited text no. 18
Mehdi Fathi, Farnad Imani, Marjan Joudi, Vahid Goodarzi. Comparison Between the Effects of Ringer's Lactate and Hydroxyethyl Starch on Hemodynamic Parameters After Spinal Anesthesia: A Randomized Clinical Trial. Anesth Pain Med 2013;2:127-33.  Back to cited text no. 19
Jabalameli M, Safavi M, Honarmand A, Saryazdi H, Moradi D, Kashefi P. The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res 2012;1:53.  Back to cited text no. 20
[PUBMED]  [Full text]  
Heidari SM, Soltani H, Hashemi SJ, Talakoub R, Soleimani B. Comparative study of two anesthesia methods according to postoperative complications and one month mortality rate in the candidates of hip surgery. J Res Med Sci 2011;16:323-30.  Back to cited text no. 21