Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery

Document Type : Original Article


Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran


Background: Spinal anesthesia is an accepted technique in hip fracture surgery and prevention of this complication by sympathomimetic agents is of potential clinical significance. The aim of this study is to compare the effect of prophylactic phenylephrine versus ephedrine in the prevention of hypotension during spinal anesthesia in hip fracture surgery.
Materials and Methods: Ninety-two patients undergoing hip fracture surgery with the American Society of Anesthesiologists I and II were randomized to receive prophylaxis with ephedrine or phenylephrine immediately before the spinal anesthesia. Patients in the ephedrine group received an intravenous (IV) bolus of 10 mg ephedrine, and patients in the phenylephrine group received an IV bolus of 50 μg phenylephrine. We recorded mean arterial pressure (MAP), systolic and diastolic blood pressure, heart rate every 3 min in the first 10 min and then every 5 min until 30 min after spinal anesthesia, nausea and vomiting, additional vasopressor, and atropine administration.
Results: The frequency of hypotension was significantly lower in MAP, systolic and diastolic pressure in group phenylephrine in 3, 6, and 9 min after spinal anesthesia (P = 0.002, P = 0.001). There were no significant differences between two groups in heart rate at different time of study. In the phenylephrine group, lower additional vasopressor was used (8.7% and 23.9%) (P = 0.04). There were no significant differences between two groups in the use of atropine (P = 0.24), nausea and vomiting.
Conclusion: At the doses of ephedrine and phenylephrine administered in this trial, phenylephrine was better to prevent hypotension during hip fracture surgery with spinal anesthesia. Higher frequency of hypotension was observed in the ephedrine group.


Zuckerman JD. Hip fracture. N Engl J Med 1996;334:1519-25.  Back to cited text no. 1
Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 1984;(186):45-56.  Back to cited text no. 2
Schultz RJ, Whitfield GF, LaMura JJ, Raciti A, Krishnamurthy S. The role of physiologic monitoring in patients with fractures of the hip. J Trauma 1985;25:309-16.  Back to cited text no. 3
Rosenberg AD. Anesthesia for major orthopedic surgery. ASA Refresher Courses in Anesthesiology 1997;25:44-131.  Back to cited text no. 4
Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth 1986;58:284-91.  Back to cited text no. 5
Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, et al. Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth 1987;59:1080-8.  Back to cited text no. 6
Stevens RD, Van Gessel E, Flory N, Fournier R, Gamulin Z. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology 2000;93:115-21.  Back to cited text no. 7
Modig J. Regional anaesthesia and blood loss. Acta Anaesthesiol Scand Suppl 1988;89:44-8.  Back to cited text no. 8
Greene NM. Physiology of Spinal Anesthesia. 3rd ed. Baltimore: Williams and Wilkins; 1981. p. 424-7.  Back to cited text no. 9
Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg 1997;85:99-105.  Back to cited text no. 10
Shibata S, Seriguchi DG, Iwadare S, Ishida Y, Shibata T. The regional and species differences on the activation of myocardial α-adrenoreceptors by phenylephrine and methoxamine. Gen Pharmacol 1980;11:173.  Back to cited text no. 11
De Vos H, Bricca G, De Keyser J, De Backer JP, Bousquet P, Vauquelin G. Imidazoline receptors, non-adrenergic idazoxan binding sites and alpha 2-adrenoceptors in the human central nervous system. Neuroscience 1994;59:589-98.  Back to cited text no. 12
Herrera R, De Andrés J, Estañ L, Olivas FJ, Martínez-Mir I, Steinfeldt T. Hemodynamic impact of isobaric levobupivacaine versus hyperbaric bupivacaine for subarachnoid anesthesia in patients aged 65 and older undergoing hip surgery. BMC Anesthesiol 2014;14:97.  Back to cited text no. 13
Nishikawa K, Yamakage M, Omote K, Namiki A. Prophylactic IM small-dose phenylephrine blunts spinal anesthesia-induced hypotensive response during surgical repair of hip fracture in the elderly. Anesth Analg 2002;95:751-6.  Back to cited text no. 14
Webb AA, Shipton EA. Re-evaluation of i.m. ephedrine as prophylaxis against hypotension associated with spinal anaesthesia for caesarean section. Can J Anaesth 1998;45:367-9.  Back to cited text no. 15
Husseini H, Abbasi H, Heidari R. Comparing the effect of mucosal phenylephrine with intravenous ephedrine on the prevention and treatment of spinal anesthesia-induced hypotension. J Shahid Sadoughi Univ Med Sci Health Serv Yazd 2002;1:3-6.  Back to cited text no. 16
Alday Muñoz E, Palacio Abizanda F, De Diego Pdel R, Gilsanz Rodríguez F. Ephedrine vs. phenylephrine by intravenous bolus and continuous infusion to prevent hypotension secondary to spinal anesthesia during cesarean section: A randomized comparative trial. Rev Esp Anesth Reanim 2011;58:412-6.  Back to cited text no. 17
Magalhães E, Govêia CS, de Araújo Ladeira LC, Nascimento BG, Kluthcouski SM. Ephedrine versus phenylephrine: Prevention of hypotension during spinal block for cesarean section and effects on the fetus. Rev Bras Anestesiol 2009;59:11-20.  Back to cited text no. 18
Aragão FF, Aragão PW, Martins CA, Salgado Filho N, Barroqueiro Ede S. Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia. Rev Bras Anestesiol 2014;64:299-306.  Back to cited text no. 19