The Efficacy of Prophylactic Ephedrine in Prevention of Hypotension During Spinal Anaesthesia for Caesarean Delivery: IM Versus IV Routes

Original article


Masoud A. Lfeituri 1, Abdul Mutaleb B. Issa 2 and Fathi M. Al Magbri 3

1-Department of Surgery, Unit of Anaesthesia and Intensive Care, Faculty of Medicine, Garyounis University, Benghazi 2- Department of Anaesthesia, Tripoli Medical Centre. Tripoli 3-Department of Anaesthesia, Misurata Central Hospital, Misurata, Libya

JMJ Vol.7, No.3 (Autumn 2007):188-191


Background: Spinal anaesthesia (SA) for caesarean section (CS) is commonly associated with hypotension (HT). This HT is treated commonly by vasopressor agents especially ephedrine. Aim of the study: We aimed to study the effect of prophylactic ephedrine, injected intramuscularly or intravenously, on the incidence of maternal HT during SA. Patients & Methods: According to the route of ephedrine injection, forty ASA I singleton parturients who presented at term for elective CS under SA were randomly assigned into two groups, each consist of 20 patients: group (IM) received intramuscular ephedrine 30mg at 15 minutes before SA, and group (IV) received intravenous ephedrine 15mg at the second minute after the SA. Patient’s monitoring included continuous ECG, heart rate, non-invasive blood pressure, and peripheral arterial oxygen saturation. SA was performed at the level of L3/L4 using a G25 spinal needle. All patients were injected intrathecally with 2.5 ml of hyperbaric 0.5% bupivacaine using the midline approach. Results: Three patients (15%) in group IM and five patients (25%) in group IV developed HT and treated with IV bolus doses of ephedrine for 5 and 10 occasions respectively. Total extradoses of ephedrine therapy required for treatment of hypotension were lower in IM group (14 mg ± 9.16) than IV group (18 mg ± 8.49), but the difference was statistically insignificant (P = 0.55). Conclusion: IM is as similar as IV ephedrine for decreasing the incidence maternal hypotension during SA. Regardless to the injection route, HT can not be completely eliminated by the prophylactic doses of ephedrine used in our study.

Keywords: Hypotension, Prophylactic Ephedrine, Spinal, Caesarean.