Background and Aims: Atonic PPH remains one of the most common causes of mortality among patients undergoing caesarean section. Oxytocin continues to be the first-line uterotonic but has undesirable effects due to its extrauterine receptor action. Carbetocin, a newer oxytocin analogue, has a better haemodynamic profile while retaining uterotonic effect and improved pharmacokinetics. Thus, this study aimed to compare the haemodynamic effects of carbetocin versus oxytocin for the prevention of PPH. Methodology: This was a double-blind randomized controlled trial performed on 60 ASA II/III parturients who underwent caesarean section under spinal anesthesia. After the delivery of the baby, patients in group A (n = 30) received Inj. carbetocin 100 µg in 10 ml saline intravenously over 1 minute followed by infusion of 0.9%NS at 10 ml/h for 4h. group B (n = 30) received Inj. oxytocin 5IU in 10 ml saline over 1 minute followed by Inj. oxytocin (10 IU/hr) at 10 ml/h for 4h. The primary objective was to compare the heart rate, systolic, diastolic, and mean arterial pressures of parturients receiving these two different medications. The secondary objectives were to compare the uterine tone, requirement of additional uterotonics, blood loss, and adverse drug effects. Results: Heart rate values at 0, 1, 3, and 5 minutes in the carbetocin group were 86.1 ± 12.615, 87.87 ± 12.176, 85.63 ± 12.979, and 83.87 ± 12.67 beats per minute, respectively. Corresponding values in the oxytocin group were 99.57 ± 12.632, 107.07 ± 14.911, 94.83 ± 14.046, and 92.43 ± 13.221 with statistically significant differences observed at all time points ( P < 0.05). Diastolic blood pressure at 0 and 1 minute in the carbetocin group was 66 ± 9.962 and 64.97 ± 9.604, respectively, compared with 60.07 ± 10.751 and 58.87 ± 11.97 ( P < 0.05) in the oxytocin group. No statistically significant differences were observed between the two groups with respect to uterine tone, blood loss, reduction in hemoglobin levels, or the incidence of nausea and vomiting. One patient in carbetocin group experienced transient chest discomfort and abdominal pain. Conclusion: This study concluded that carbetocin causes less tachycardia than oxytocin.
Ramachandran et al. (Thu,) studied this question.