# Caffeine before cesarean delivery: a novel preventive strategy against spinal hypotension, a double blind placebo-controlled trial

## TL;DR

Taking caffeine before a cesarean delivery can help prevent low blood pressure and reduce side effects like nausea and headaches.

## Contribution

This is the first randomized trial to show that preoperative caffeine reduces spinal anesthesia-induced hypotension and related complications.

## Key findings

- Caffeine reduced hypotension incidence from 33% to 9% and eliminated severe cases.
- Caffeine lowered postoperative nausea and vomiting (2% vs. 20%) and post-dural puncture headache (2% vs. 16%).
- Caffeine improved hemodynamic stability and reduced ephedrine requirements.

## Abstract

Spinal anesthesia-induced hypotension is a common complication during cesarean delivery, often requiring vasopressor support, and is associated with maternal discomfort. Caffeine, a central nervous system stimulant with well-documented cardiovascular effects, may provide a simple adjunct to enhance hemodynamic stability. We aimed to evaluate the efficacy of a single preoperative 200 mg oral caffeine dose in reducing the incidence and severity of hypotension following spinal anesthesia in healthy patients undergoing elective cesarean delivery.

In this randomized controlled trial, 90 patients classified as ASA II and scheduled for elective cesarean delivery under spinal anesthesia were assigned to receive either 200 mg oral caffeine or a placebo 30 min before the procedure. Hemodynamic parameters, the incidence and severity of hypotension, baseline and 60 min post-administration serum caffeine levels, ephedrine requirements, incidence of postoperative nausea and vomiting, and post-dural puncture headache were recorded and analyzed.

Caffeine administration significantly reduced the incidence of hypotension (9% vs. 33%, p < 0.05). Severe hypotension was not observed in the caffeine group. Patients in the caffeine group demonstrated greater hemodynamic stability, with a delayed onset of hypotension and reduced ephedrine requirements. No significant differences were observed in the incidence of bradycardia, tachycardia, or reactive hypertension. Neonatal outcomes were comparable between the groups. Additionally, caffeine was associated with lower rates of postoperative nausea and vomiting (2% vs. 20%) and post-dural puncture headache (2% vs. 16%) at 24 h.

Preoperative administration of 200 mg oral caffeine is a cost-effective strategy for reducing spinal anesthesia-induced hypotension, the incidence of postoperative nausea and vomiting, and post-dural puncture headache in healthy patients undergoing elective cesarean delivery. These findings support further investigation of the role of caffeine as an adjunct in obstetric anesthesia.

The study was registered by the principal investigator (M. Helmy) at ClinicalTrials.gov under the identifier NCT07076654 on July 11, 2025.

This is the first randomized trial to assess the influence of preoperative 200 mg oral caffeine on the incidence and severity of spinal anesthesia-induced hypotension.200 mg of oral caffeine reduces the incidence and severity of spinal-induced hypotension.Beyond its hemodynamic effect, it reduces the incidence of postoperative nausea and vomiting and post-dural puncture headache.

This is the first randomized trial to assess the influence of preoperative 200 mg oral caffeine on the incidence and severity of spinal anesthesia-induced hypotension.

200 mg of oral caffeine reduces the incidence and severity of spinal-induced hypotension.

Beyond its hemodynamic effect, it reduces the incidence of postoperative nausea and vomiting and post-dural puncture headache.