A Systematic Review Comparing Ephedrine Versus Phenylephrine During Spinal Anesthesia for Cesarean Delivery

Shelby Sullivan


This systematic review compared the efficacy and safety of ephedrine with phenylephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Hypotension during cesarean section delivery can have detrimental effects on both the mother and the neonate. Some vasoactive medications such as ephedrine and phenylephrine have been found to be detrimental to the neonate and divert fetal blood flow. After a systematic search of the electronic database PubMed, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart was used to identify appropriate research. Studies were illustrated in a table to identify key variables and were then critically appraised. Outcomes included oxygen supplementation use, ASA classification, IV fluid prehydration, hypotension incidence after spinal anesthesia, spinal solution and technique, umbilical artery pH, Apgar scores, and nausea and vomiting during the case. Findings revealed no difference in the use of oxygen supplementation, ASA classification, IV fluid prehydration, spinal solution or technique on fetal umbilical artery pH. Women given phenylephrine had neonates with higher umbilical artery pH values than those given ephedrine but there was no significant difference between the two vasopressors in the incidence of true fetal acidosis (umbilical artery pH < 7.20 or Apgar <7 at 1 and 5 min). There was an incidental finding from two studies that additionally examined nausea and vomiting that there was an increase occurrence of nausea and vomiting with ephedrine administration as compared to phenylephrine administration. This systematic review supports the view that ephedrine and phenylephrine have equal efficacy and safety when administered to obstetric patients experiencing hypotension after spinal anesthesia during cesarean sections.