Vol. 7, Issue 2, Part A (2025)

Objective: This study was conducted to compare the effectiveness of preloading and coloading of crystalloids in prevention of spinal anaesthesia induced maternal hypotension during elective caesarean section and to determine the incidence of hypotension and vasopressor requirement for the maintenance of blood pressure in both groups.

Methods: A prospective comparative study was conducted among 66 patients who were divided into Group P (Preloading): 33 patients, for whom 15 ml/kg Ringer Lactate (RL) solution was given over 20 minutes prior to spinal anaesthesia; Group C (Coloading): 33 patients, for whom 15 ml/kg RL solution was given over 20 minutes at the time of administration of spinal anaesthesia. Spinal anaesthesia was administered in a standardized manner with a dural puncture at L3-L4 level using 25 G Quincke Babcock spinal needle and administration of an assigned group of intrathecal drugs. Hypotension was treated by using incremental doses of injection ephedrine 3 mg intravenously and fluid bolus. Blood pressure was measured every 5 minutes for the first half an hour, then every 15 minutes till 120 minutes. The side effects of hypotension, APGAR score of infants, and overall duration of spinal anaesthesia are recorded and analysed.

Result: We observed that 5 out of the 33 patients (15.2%) in Group C and 13 out of the 33 patients (39.4%) in Group P had episode(s) of hypotension. On an average 1.2 gms of ephedrine was required in Group C, while 1.92 gms of ephedrine was needed for Group P. We observed a significant statistical difference between the incidence of hypotension (p = 0.027). There was no statistically significant difference in the mean age (p = 1), weight (p = 0.80), and height (p = 0.87). The baseline systolic blood pressure, mean arterial blood pressure and pulse rates were also similar in the two groups.

Conclusion: This study demonstrated that co-load is better than preload in the prevention of spinal anaesthesia-induced hypotension during caesarean section. A larger clinical trial in the Indian context is advisable.