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An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery.
Int J Obstet Anesth. 2017 Feb; 29:18-25.IJ

Abstract

BACKGROUND

During spinal anesthesia for cesarean delivery phenylephrine is the vasopressor of choice but can cause bradycardia. Norepinephrine has both β- and α-adrenergic activity suitable for maintaining blood pressure with less bradycardia. We hypothesized that norepinephrine would be superior to phenylephrine, requiring fewer rescue bolus interventions to maintain blood pressure.

METHODS

Eighty-five parturients having spinal anesthesia for elective cesarean delivery were randomized to Group P (phenylephrine 0.1μg/kg/min) or Group N (norepinephrine 0.05μg/kg/min) fixed-rate infusions. Rescue bolus interventions of phenylephrine 100μg for hypotension, or ephedrine 5mg for bradycardia with hypotension, were given as required to maintain systolic blood pressure. Maternal hemodynamic variables were measured non-invasively.

RESULTS

There was no difference between groups in the proportion of patients who required rescue vasopressor boluses (Group P: 65.8% [n=25] vs. Group N: 48.8% [n=21], P=0.12). The proportion of patients who received ⩾1 bolus of phenylephrine was similar between groups (Group P: 52.6% [n=20] vs. Group N: 46.5% [n=20], P=0.58). However, more patients received ⩾1 bolus of ephedrine in the phenylephrine group (Group P: 23.7% [n=9] vs. Group N: 2.3% [n=1], P<0.01). The incidence of emesis was greater in the phenylephrine group (Group P: 26.3% vs. Group P: 16.3%, P<0.001). Hemodynamic parameters including heart rate, the incidence of bradycardia, blood pressure, cardiac output, cardiac index, stroke volume, and systemic vascular resistance and neonatal outcome were similar between groups (all P<0.05).

CONCLUSION

Norepinephrine fixed-rate infusion has efficacy for preventing hypotension and can be considered as an alternative to phenylephrine.

Authors+Show Affiliations

West Virginia University School of Medicine, Morgantown, WV, USA. Electronic address: vallejom@wvumedicine.org.West Virginia University School of Medicine, Morgantown, WV, USA.West Virginia University School of Medicine, Morgantown, WV, USA.West Virginia University School of Medicine, Morgantown, WV, USA.Duquesne University School of Business, Pittsburgh, PA, USA.West Virginia University School of Medicine, Morgantown, WV, USA.West Virginia University School of Medicine, Morgantown, WV, USA.West Virginia University School of Medicine, Morgantown, WV, USA.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27720613

Citation

Vallejo, M C., et al. "An Open-label Randomized Controlled Clinical Trial for Comparison of Continuous Phenylephrine Versus Norepinephrine Infusion in Prevention of Spinal Hypotension During Cesarean Delivery." International Journal of Obstetric Anesthesia, vol. 29, 2017, pp. 18-25.
Vallejo MC, Attaallah AF, Elzamzamy OM, et al. An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery. Int J Obstet Anesth. 2017;29:18-25.
Vallejo, M. C., Attaallah, A. F., Elzamzamy, O. M., Cifarelli, D. T., Phelps, A. L., Hobbs, G. R., Shapiro, R. E., & Ranganathan, P. (2017). An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery. International Journal of Obstetric Anesthesia, 29, 18-25. https://doi.org/10.1016/j.ijoa.2016.08.005
Vallejo MC, et al. An Open-label Randomized Controlled Clinical Trial for Comparison of Continuous Phenylephrine Versus Norepinephrine Infusion in Prevention of Spinal Hypotension During Cesarean Delivery. Int J Obstet Anesth. 2017;29:18-25. PubMed PMID: 27720613.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery. AU - Vallejo,M C, AU - Attaallah,A F, AU - Elzamzamy,O M, AU - Cifarelli,D T, AU - Phelps,A L, AU - Hobbs,G R, AU - Shapiro,R E, AU - Ranganathan,P, Y1 - 2016/08/28/ PY - 2016/03/18/received PY - 2016/06/24/revised PY - 2016/08/21/accepted PY - 2016/10/11/pubmed PY - 2017/8/17/medline PY - 2016/10/11/entrez KW - Cesarean delivery KW - Norepinephrine KW - Phenylephrine KW - Spinal anesthesia SP - 18 EP - 25 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 29 N2 - BACKGROUND: During spinal anesthesia for cesarean delivery phenylephrine is the vasopressor of choice but can cause bradycardia. Norepinephrine has both β- and α-adrenergic activity suitable for maintaining blood pressure with less bradycardia. We hypothesized that norepinephrine would be superior to phenylephrine, requiring fewer rescue bolus interventions to maintain blood pressure. METHODS: Eighty-five parturients having spinal anesthesia for elective cesarean delivery were randomized to Group P (phenylephrine 0.1μg/kg/min) or Group N (norepinephrine 0.05μg/kg/min) fixed-rate infusions. Rescue bolus interventions of phenylephrine 100μg for hypotension, or ephedrine 5mg for bradycardia with hypotension, were given as required to maintain systolic blood pressure. Maternal hemodynamic variables were measured non-invasively. RESULTS: There was no difference between groups in the proportion of patients who required rescue vasopressor boluses (Group P: 65.8% [n=25] vs. Group N: 48.8% [n=21], P=0.12). The proportion of patients who received ⩾1 bolus of phenylephrine was similar between groups (Group P: 52.6% [n=20] vs. Group N: 46.5% [n=20], P=0.58). However, more patients received ⩾1 bolus of ephedrine in the phenylephrine group (Group P: 23.7% [n=9] vs. Group N: 2.3% [n=1], P<0.01). The incidence of emesis was greater in the phenylephrine group (Group P: 26.3% vs. Group P: 16.3%, P<0.001). Hemodynamic parameters including heart rate, the incidence of bradycardia, blood pressure, cardiac output, cardiac index, stroke volume, and systemic vascular resistance and neonatal outcome were similar between groups (all P<0.05). CONCLUSION: Norepinephrine fixed-rate infusion has efficacy for preventing hypotension and can be considered as an alternative to phenylephrine. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/27720613/An_open_label_randomized_controlled_clinical_trial_for_comparison_of_continuous_phenylephrine_versus_norepinephrine_infusion_in_prevention_of_spinal_hypotension_during_cesarean_delivery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(16)30069-3 DB - PRIME DP - Unbound Medicine ER -