A randomized controlled dose-finding study showed that Epinephrine use is associated with spinal hypotension prevention during Cesarean delivery. To avoid spinal hypotension following Cesarean delivery, researchers compared three dosages of Epinephrine. Included were full-term pregnant females who were scheduled to undergo an elective C-section under spinal anesthesia.

Prophylactic Epinephrine infusions were given to the subjects at rates of 0.01, 0.02, or 0.03 mcg/kg/min. Using a 9-mg Ephedrine bolus, management of spinal hypotension (systolic blood pressure less than 80% of the baseline) was done. The occurrence of spinal hypotension was the major endpoint ascertained.  The total Ephedrine required, the occurrence of severe spinal hypotension, excessive hypertension and tachycardia, and neonatal outcomes were the secondary outcomes ascertained. Overall, 271 subjects were incorporated in the final assessment.

The occurrence of hypotension was lowest in the group receiving 0.03 mcg (11/90 [12%]). This was followed by 0.02 mcg (32/91 [35%]), and 0.01 mcg (55/90 [61%]) arms. The 0.03 mcg arm (0 [0-0] mg) had the lowest median Ephedrine needs (quartiles). This was followed by the 0.02 mcg (0 [0-9] mg) and the 0.01 mcg (9 [0-18] mg) arms. In contrast to the 0.01 mcg group, the incidence of severe hypotension was reduced in the 0.03 mcg and 0.02 mcg groups (15/90 [17%], 3/90 [3%], and 5/91 [6%] respectively).

The groups had similar occurrences of excessive neonatal outcomes, hypertension, and tachycardia. Epinephrine usage can be beneficial to prevent spinal hypotension after C-section. In comparison to initial dosages of 0.02 mcg/kg/min and 0.01 mcg/kg/min, 0.03 mcg/kg/min produced the lowest occurrence of hypotension. In terms of the occurrence of hypertension, tachycardia, and neonatal outcomes, the 3 dosages were similar.