Dr Saad Karim, Dr Tehreem Zia, Dr Novera Ansar
Objectives: To compare the efficacy of prophylactic combination therapy using IV ephedrine in bolus doses in conjunction with fluid preload as compared to fluid preload alone or IV ephedrine alone, for prevention of maternal hypotension after spinal anesthesia for caesarean section. Methodology: This in-hospital study was conducted at the Department of Anesthesiology Bahawal Victoria Hospital, Bahawalpur for one-year duration from April 2019 to April 2020. Ninety Grade I ASA patients undergoing spinal anesthesia for elective caesarean section were randomized into three groups. Group I (Crystalloid group) received only a pre-fluid load with Ringer's solution of 20 ml / kg body weight; Group II (ephedrine group) received IV ephedrine 0.25 mg / kg body weight only after initiation of SAB, and group III (combined group) received an initial Ringer's solution fluid load of 20 ml / kg body weight plus ephedrine 0.25 mg / kg body weight administered intravenously after the start of spinal anesthesia. Intraoperative hemodynamic changes and fetal outcomes were monitored, recorded and the data statistically analyzed. Results: Although the incidence of hypotension was not significant in all three groups, hemodynamic stability was significantly better and sustained in group III receiving combination therapy. Conclusions: Prophylactic combination therapy with preloading fluids in combination with intravenous ephedrine 0.25 mg / kg BW can effectively prevent spinal hypotension in the mother during cesarean section. Keywords: combination therapy, spinal anesthesia; Caesarean section; ephedrine; hypotension.