Comparison of total vasopressor requirement in elective caesarean section under subarachnoid block for patients preloaded with 500ml of 6 % pentastarch versus1000ml of ringer’s lactate.—a randomised clinical trail

Abstract

INTRODUCTION: 

In recent times, delivery by caesarean section has become common and subarachnoid block appears to be the technique of choice as it is reliable, however it can cause hypotension which is associated with increased morbidity and mortality; thus, its prevention is important in parturients. Qualitative systematic review has shown hypotension can be better prevented with volume preloading using colloid which is consistently more effective than crystalloids in preventing hypotension. Among the commercially available colloids 6% Pentastarch in 0.9% saline has the best safety profile. 

AIM: 

To compare the efficacy of 1000ml Ringer’s lactate to that of 500ml 6% Pentastarch in preventing the incidence and severity of hypotension (total usage of vasopressor ephedrine) in parturient undergoing lower segment caesarean section under subarachnoid block.

MATERIALS AND METHODS: 

The present randomized clinical study was conducted in the Department of Anaesthesiology BGS GIMS from 28th July 2022 to 28th November 2022 in 60 parturient of ASA I and II aged between 20-32 years undergoing elective cesarean section under subarachnoid block who were randomly divided into two groups, Group P (n=30) who received 6% PENTASTARCH 500ml IV and Group R (n=30) who received RINGER’S LACTATE 1000ml IV 20 minutes prior to the block. Demographic data, hemodynamic parameters like SBP, DBP, MAP and total vasopressor (ephedrine) requirement were noted. The Statistical software namely SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data. Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between groups.

RESULTS: 

A total of 60 parturients were studied, there were no significant differences in demographic data between the two groups. The incidence of hypotension (SBP, DBP, MAP) was significantly lesser with p<0.001 in patients belonging to the 6% pentastarch group (P) than in patients of ringer lactate group (R). The usage of ephedrine was significantly more in group R parturients with 28 of the 30-requiring vasopressors (93.3%) as compared to group P where in only 10 of the 30 patients (33.3%) required ephedrine. 

CONCLUSION:

It can be concluded that the incidence of hypotension after SAB in parturients can be reduced by volume preloading with colloids like pentastarch as compared to crystalloids like ringer lactate. This also reduces the aggressive use of vasopressors intraoperatively to maintain haemodynamic stability in parturients.