Comparing the Effect of Spinal Bupivacaine versus Spinal Prilocaine on Maternal Blood Pressure in Caesarean Section: A Randomized Controlled Trial

Sayed, Zeinab Mustafa; Mahran, Omima Emadeldin; Ahmed, Mohamed Gaber

doi:10.21608/egja.2025.386487.1091

Comparing the Effect of Spinal Bupivacaine versus Spinal Prilocaine on Maternal Blood Pressure in Caesarean Section: A Randomized Controlled Trial

Document Type : Original Article

Authors

¹ Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, South Valley University, Qena, Egypt

² Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Sohag University, Sohag, Egypt.

³ Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, South Valley University, Qena, Egypt.

10.21608/egja.2025.386487.1091

Abstract

Background: Hypotension following spinal anesthesia (SA) occurs in 80-90% of parturients undergoing caesarean section (CS), potentially compromising maternal and fetal outcomes. This study evaluated the hemodynamic effects and recovery profiles of spinal bupivacaine versus prilocaine in parturients undergoing CS.
Methods: This triple-blinded randomized trial included 120 pregnant women (aged 18-35 years old) scheduled for CS. Participants received either 10mg hyperbaric bupivacaine 0.5% in Group A or 50mg hyperbaric prilocaine 2% in Group B, combined with 100μg morphine (total volume 3ml). Maternal blood pressure (BP) was measured at baseline, every 3 minutes during the first 15 minutes post-SA, every 5 minutes until surgery completion, and hourly for 6 hours postoperatively.
Results: Group A exhibited significantly lower systolic and diastolic BP at 3- and 6-minutes post-SA than Group B (p<0.05). Group A required significantly higher ephedrine doses than Group B (27.93±11.6mg versus 8.39±4.54mg; p<0.001). Motor block recovery was substantially faster in Group B, with significant differences emerging at 30 minutes postoperatively and persisting through 180 minutes (p<0.001 at all-time points). Complication rates were comparable between groups.
Conclusions: Spinal prilocaine demonstrates superior hemodynamic stability with lower vasopressor requirements and faster motor recovery compared to bupivacaine for CS, these benefits support the use of prilocaine in enhanced recovery pathways for CS.

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