Comparison of Noradrenaline and Ephedrine for Maintaining Maternal Hemodynamic Stability and Neonatal Outcomes during Spinal Anesthesia for Caesarean Section: A Prospective Comparative Study

Hana Almashkawi; Mesad Ghula; Asem Suleiman; Fadia Oshkondale; Amna Jurmi; Hatem Omar; Melad Shikondali

doi:10.54361/ajmas.269521

Authors

Hana Almashkawi Academic Surgical Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0000-0001-8336-0463
Mesad Ghula Academic Surgical Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0000-0002-0361-1021
Asem Suleiman Academic Surgical Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0009-0001-0238-2247
Fadia Oshkondale Pharmacological Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0009-0008-2792-2343
Amna Jurmi Anesthesia and Intensive Care Department, Zawia Medical Center, Zawia, Libya https://orcid.org/0000-0003-2078-9662
Hatem Omar Pediatric Department, Faculty of Medicine, University of Zawia, Libya https://orcid.org/0000-0002-1254-7586
Melad Shikondali Department of Anesthesiology, Intensive Care, and Emergency Medicine, Marien Hospital Papenburg Aschendorf, Germany https://orcid.org/0009-0001-3846-8982

DOI:

https://doi.org/10.54361/ajmas.269521

Keywords:

Spinal Anesthesia, Caesarean Section, Noradrenaline, Ephedrine, Maternal.

Abstract

Spinal anesthesia-induced hypotension (SAIH) complicates up to 70–80% of caesarean sections performed under spinal block, threatening both maternal organ perfusion and uteroplacental blood flow. Ephedrine has been the traditional first-line vasopressor, but accumulating evidence points to its beta-adrenergic metabolic effects as a source of fetal acidosis. Noradrenaline (norepinephrine), a predominantly alpha (α) adrenergic agent, has emerged as a promising alternative, though data from North African populations remain scarce. Seventy Parturients undergoing elective or urgent caesarean section at Zawia Medical Centre, Libya, were assigned to receive either ephedrine 6 mg IV (Group E, n=35) or noradrenaline 16 µg IV (Group N, n=35) as rescue therapy whenever mean arterial pressure (MAP) fell below 65 mmHg following spinal anesthesia. Hemodynamic parameters were recorded at five-minute intervals for 45 minutes. Primary outcomes were the incidence of hypotension and intraoperative MAP profiles. Secondary outcomes included neonatal Apgar scores at one and five minutes, and maternal side effects (nausea, vomiting, shivering). The two groups were comparable in age, weight, height, and baseline heart rate (all p>0.05). Baseline MAP was slightly higher in Group E (93.4 ± 11.3 vs 88.1 ± 8.5 mmHg; p=0.039), though this difference did not translate into clinically meaningful differences in intraoperative MAP (p=0.119) or hypotension incidence (40.0% vs 33.3%; p=0.766). Intraoperative heart rate was significantly higher in Group E (99.4 ± 13.2 vs 92.6 ± 10.9 bpm; p=0.033). Neonatal Apgar scores were significantly higher in the noradrenaline group (median 9 vs 8; p<0.001). Nausea occurred universally in Group N (100% vs 54.3%; p<0.001), while vomiting tended to be more frequent in Group E (40.0% vs 16.7%; p=0.074). Noradrenaline and ephedrine produced equivalent maternal hemodynamic profiles during spinal anesthesia for caesarean section. Noradrenaline was associated with better neonatal Apgar scores but a higher rate of maternal nausea. These findings support the use of noradrenaline as a viable first-line vasopressor in obstetric anesthesia in Libya, with attention to antiemetic co-administration.