Norepinephrine versus ephedrine for the prevention of spinal anesthesia-induced hypotension in coronary artery disease patients undergoing knee arthroscopy

Background Spinal anesthesia, a popular technique used for lower limb surgery in coronary artery disease patients, could be associated with hypotension, which could be managed with colloids, vasopressor, ephedrine, or norepinephrine (NE). Aim The aim of this study was to assess the efficacy and safety of bolus administration of NE versus ephedrine for the maintenance of systolic blood pressure during spinal anesthesia in coronary artery disease patients undergoing knee arthroscopy. Patients and methods A randomized, controlled, double-blinded study was carried out on 100 ASA II or III coronary artery disease patients undergoing knee arthroscopy. The patients were divided into two groups of 50 patients each: the ephedrine group (group EPH) and the norepinephrine group (group NE). When hypotension occurred, group EPH received 5 mg of ephedrine and group NE received 5 μg of NE. Systolic blood pressure and heart rate were recorded at 0, 5, 10, 15, 30, and 60 min, and side effects of both drugs were also recorded. Results Efficacy was found in 20 (40%) patients of group EPH and in 40 (80%) patients of group NE. The results were highly significant (P 0.0001). Tachycardia was significantly higher (P 0.0001) in group EPH. The incidence of hypotension, hypertension, and bradycardia was not significantly different between the two groups. Conclusion NE is more effective compared with ephedrine in the maintenance of systolic blood pressure with reduction in heart rate, which is useful in coronary artery disease patients undergoing knee arthroscopy under spinal anesthesia in whom tachycardia is undesirable.