Effect of Different Vasopressors for the Management of Spinal Anesthesia-Induced Hypotension during Cesarean Section and Postnatal Chart in Tripoli, Libya

Abstract

Spinal-induced hypotension (SIH) remains a prevalent and clinically consequential complication of neuraxial anaesthesia for cesarean delivery. Its pathophysiological sequelae include maternal symptomatology (nausea, vomiting, dizziness) and impaired uterine-placental perfusion, predisposing to fetal acidosis and diminished fetal Apgar scores. Judicious selection of a vasopressor agent is therefore paramount. This study sought to compare the efficacy of ephedrine, norepinephrine, and a combined regimen in the management of SIH during cesarean section, with respect to maternal hemodynamic stability, neonatal outcomes, and adverse event profiles. This study was a prospective cross-sectional clinical analysis conducted at Al-Hadba Al-Khadra General Hospital in Tripoli, Libya. A total of 170 parturients were enrolled and divided into four groups: ephedrine (n = 60), norepinephrine (n = 60), combined (n = 20), and a control group (n = 30). Hemodynamic parameters were recorded at eleven perioperative time points. Apgar scores were assessed at both one and five minutes after delivery, and maternal adverse effects were documented. Statistical analysis was carried out using SPSS version 25, applying one-way ANOVA, the Kruskal-Wallis test, repeated-measures ANOVA, Pearson correlation, and chi-square tests. A p-value of less than 0.05 was considered statistically significant. Baseline demographic and clinical characteristics were comparable across all groups. All vasopressor regimens successfully restored blood pressure within 30–45 minutes. The combined group exhibited the most pronounced early reduction in systolic and mean arterial pressures at the five-minute interval, whereas norepinephrine demonstrated the most stable hemodynamic profile with minimal fluctuation relative to ephedrine. Apgar scores did not differ significantly among groups. Nausea and vomiting were reported across all cohorts; tachycardia was predominantly observed in the ephedrine group, while sporadic bradycardia occurred in those receiving norepinephrine. All vasopressor agents effectively controlled SIH without compromising neonatal outcomes. Norepinephrine may be the preferred agent owing to its superior hemodynamic stability and reduced propensity for tachyarrhythmia. Larger-scale, multi-centre investigations are warranted to corroborate these findings.