AbstractObjective To compare the clinical efficacy of ephedrine and methoxamine in the treatment of spinal anesthesia-associated hypotension under cesarean section. Methods A retrospective study was conducted on the clinical data of 60 patients with cesarean section who had hypotension during spinal anesthesia, including group A (n=30, 10 mg ephedrine intravenously) and group B (n=30, 2 mg methoxamine intravenously) according to the treatment plans. The changes of maternal blood pressure (BP), heart rate (HR), fetal umbilical arterial blood gas and adverse reactions were compared. Results There was no significant difference in systolic blood pressure between the two groups 15 minutes before and after anesthesia (P>0.05). The heart rate of group A was significantly higher than that of group B after 6 minutes of anesthesia (P<0.05). The umbilical arterial blood pH, PaO2 and PaCO2 in group A were lower than those in group B, and the difference in pH value between the two groups was significant (P<0.05). The hypotension of group A was lower than that of group B. However, it didn't show statistical significance (P>0.05). The incidence of bradycardia in group A was more than that in group B (P<0.05). Conclusion Both ephedrine and methoxamine can increase spinal anesthesia-associated hypotension under cesarean section with accurate effect. There is no serious adverse reaction in the maternal. Heart rate control by methoxamine is more stable and can be promoted clinically.