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Comparison of ephedrine and phenylephrine in incidence of headache during spinal anesthesia in cesarean delivery

Mitra Yari, Mansour Choubsaz, Hossein Farzam, Elham Siahkamari, Parisa Golfam

Background: Spinal anesthesia is more acceptable method of anesthesia in elective cesarean section, but hypotension is the major limitation of this technique which might trigger to serious complications for both mother and fetus. The use of vasopressors is necessary to control hypotension caused by spinal anesthesia, however, it might be along with side effects like headache.

Methods: In the present study, 105 candidates for elective cesarean delivery were assessed to compare the role of ephedrine and phenylephrine in relation with the incidence of headache. Pearson Chi-square test, Kruskal-Wallis test, Spearman's rho correlation coefficient was performed to analyse the data. P value<0.05 was considered significant. All data were analysed using Stata 12.

Results: The incidence of headache during the surgery was 51.4%, 45.7% and 37.1% in ephedrine, phenylephrine and control groups respectively. Not a significant difference was found between ephedrine and phenylephrine regarding the incidence of headache (P=0.541), also no significant difference were found in the severity of the headache (P=0.277). The severity of the headache was not different 24 h after surgery. The number of doses of vasopressor consumption in ephedrine and phenylephrine recipients was not significantly different (P=0.579). No significant difference was found between the number of doses used and the severity of the headache during surgery (P=0.979). However, the average of systolic blood pressure in ephedrine group was higher than phenylephrine group (P=0.001). Also, the impact of ephedrine and phenylephrine on heart rate was similar and affectless.

Conclusions: In this study, no significant differences were observed in the incidence and severity of headaches during and after surgery, and the number of doses of vasopressor drug consumption between phenylephrine and ephedrine recipients to treat hypotension associated with spinal anesthesia in cesarean section.