Background: There is increasing attitude to use norepinephrine for prevention of spinal hypotension. Though, data is not adequate for routine use in clinical practice.
Aim of the study was to compare the effectiveness and safety of norepinephrine infusion versus ephedrine infusion for prevention of spinal hypotension. The primary outcome was maintaining systolic blood pressure changes within 20% of baseline.
Methods: In our prospec‌tive double blinded randomized study, we studied 130 patients, underwent elective surgeries under spinal anesthesia. Patients were randomly divided into two equal groups: Ephedrine group; received ephedrine (5mg/ml), and Norepinephrine group; received norepinephrine (5µg/ml). After spinal anesthesia, the study drug was started at a rate 30ml/h and adjusted according to blood pressure. Hypotension was treated by 1 ml bolus of the study drug. We assessed; systolic blood pressure, pulse, total volume of infusion, need for boluses, and complications.
Results: Systolic blood pressure decreased in both groups in comparison to baseline at 2, 4, 6, and 8 minutes. When comparing both groups; blood pressure was lower in ephedrine group after 2 and 4 minutes, after that both groups were comparable. There was increase in heart rate in the 1st 10 minutes in ephedrine group. Attacks of tachycardia and hypertension occurred more in ephedrine group, but no differences regarding volume of infusion, need for boluses, attacks of bradycardia or hypotension.
Conclusion: both drugs are effective in prevention of spinal hypotension, but norepinephrine has faster onset with fewer episodes of tachycardia and hypertension leading to better hemodynamic stability.