Background and aims There are limited data on safety and efficacy of epinephrine (E) for prophylaxis and treatment of spinal-hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on treatment of spinal-hypotension and ephedrine requirement during cesarean deliveries.

Methods They were allocated randomly to receive norepinephrine 5 μg/mL (group NE,n=40), epinephrine 5 μg/mL (group E,n=40), phenylephrine100 μg/mL (group PE,n=40) or 0.9% saline infusions (group S, n=40), immediately after induction of spinal anesthesia. Whenever systolic blood pressure fell to less than 90 mmHg, 5 mg ephedrine was administered. Hemodynamic variables were measured preoperatively, 1-minute intervals for 15 minutes and with 2.5-minutes intervals till end of surgery. the incidence of hypotension, total number of hypotension episodes, number of patients requiring ephedrine, mean amounts of ephedrine, atropine consumption was recorded.

Results The incidence of bradycardia and mean atropine consumptions were similar between groups. There was no statistically significant difference in incidence of hypotension between the groups. the number of patients requiring ephedrine was significantly greater in group S than in group PE (p=0.001). However, it was similar between groups PE, NE, and E. There was no significant difference in number of hypotension episodes between the groups. the mean ephedrine consumption was significantly higher in group S than other groups(p=0.001).

Conclusions Epinephrine infusion (150 µg/h) was as effective as norepinephrine (150 µg/h) infusion, with similar incidences of hypotension and ephedrine consumption, and can be considered as an alternative agent for management of hypotension. However, phenylephrine infusion (3 mg/h) was the most effective drug for management of spinal hypotension during cesarean.