Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia

Objective: The frequency of maternal hypotension after spinal anesthesia in Caesarean section (CS) may be as high as 90%. The aim of this study was to investigate the effect of the use of the combination of ephedrine and norepinephrine on maternal hemodynamics, neonatal APGAR and acidosis in CS delivery under spinal anesthesia. Methods: This prospective, randomized, double-blind study included pregnant patients aged 18 - 45 years, evaluated as ASA class I-II for surgery, who underwent elective CS under spinal anesthesia. The clinical and laboratory findings, umbilical blood gases, maternal blood pressure and heart rate were also analyzed. The patients were randomly separated into 3 groups: Ephedrine (E), Ephedrine+Norepinephrine (EN), and Norepinephrine (N). Results: Umbilical cord venous blood pH and HCO3 was lower in Group EN than the other groups. APGAR score was lower in Group E. Heart rate in Groups EN and N decreased up to the middle of surgery, then was slightly elevated until the end of surgery. Heart rate persistently decreased in Group E from the beginning to the end of the surgery. SBP decreased significantly at the end of the surgery compared to basal levels in Group EN and N, and did not decrease significantly in Group E. Conclusion: These findings suggest that the addition of norepinephrine to ephedrine might increase the risk of fetal acidosis and affect the APGAR score. The longer duration of action and the higher number of bolus of ephedrine might be associated with a lesser decrease in maternal blood pressure after the middle of the surgery.