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Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial.
Anaesth Crit Care Pain Med. 2019 12; 38(6):601-607.AC

Abstract

BACKGROUND

Prophylactic vasopressors are fundamental during caesarean delivery under spinal anaesthesia. The aim of this work is to compare the efficacy and safety of phenylephrine and norepinephrine when used in variable infusion rate during caesarean delivery.

METHODS

A randomised, double-blinded, controlled trial was conducted including mothers scheduled for elective caesarean delivery under spinal anaesthesia. Participants were allocated to two groups norepinephrine group (n = 60), and phenylephrine group (n = 63). Participants received prophylactic vasopressors after spinal block at rate started at 0.05 mcg/kg/min and 0.75 mcg/kg/min respectively. The rate of vasopressor infusion was manually adjusted according to maternal systolic blood pressure. Both groups were compared according to incidence of post-spinal hypotension (the primary outcome), incidence of bradycardia, incidence of reactive hypertension, systolic blood pressure, heart rate, rescue vasopressor consumption, number of physician interventions, and neonatal outcomes.

RESULTS

One hundred and twenty-three mothers were available for final analysis. Both groups were comparable in the incidence of post-spinal hypotension (32% versus 30%, P = 0.8). The number of physician intervention was lower in norepinephrine group. The incidence of bradycardia and the incidence of reactive hypertension were potentially lower in norepinephrine group without reaching statistical significance, (13% vs. 21%, P = 0.3) and (12% vs. 24%, P = 0.1). Rescue vasopressor consumption, and neonatal outcomes were comparable between both groups.

CONCLUSION

When given in a manually adjusted infusion, norepinephrine effectively maintained maternal SBP during caesarean delivery under spinal anaesthesia with lower number of physician interventions, and likely less incidence of reactive hypertension and bradycardia compared to phenylephrine.

Authors+Show Affiliations

Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: ahmedmohamedhasanin@gmail.com.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: sarahamin_22@hotmail.com.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: sherin.refaat@hotmail.com.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: sara.farouk2020@cu.edu.eg.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: marwa.zayed@kasralainy.edu.eg.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: yaserabdelwahab@gmail.com.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: mssayad@hotmail.com.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: maha.mostafa@cu.edu.eg.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: mazenheba82@yahoo.com.Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: dr.ahmedelshall@gmail.com.Department of obstetrics and gynaecology, Cairo university, Cairo, Egypt. Electronic address: shimaa.mostafa@kasralainy.edu.eg.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30935897

Citation

Hasanin, Ahmed, et al. "Norepinephrine Versus Phenylephrine Infusion for Prophylaxis Against Post-spinal Anaesthesia Hypotension During Elective Caesarean Delivery: a Randomised Controlled Trial." Anaesthesia, Critical Care & Pain Medicine, vol. 38, no. 6, 2019, pp. 601-607.
Hasanin A, Amin S, Refaat S, et al. Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial. Anaesth Crit Care Pain Med. 2019;38(6):601-607.
Hasanin, A., Amin, S., Refaat, S., Habib, S., Zayed, M., Abdelwahab, Y., Elsayad, M., Mostafa, M., Raafat, H., Elshall, A., & Fatah, S. A. E. (2019). Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial. Anaesthesia, Critical Care & Pain Medicine, 38(6), 601-607. https://doi.org/10.1016/j.accpm.2019.03.005
Hasanin A, et al. Norepinephrine Versus Phenylephrine Infusion for Prophylaxis Against Post-spinal Anaesthesia Hypotension During Elective Caesarean Delivery: a Randomised Controlled Trial. Anaesth Crit Care Pain Med. 2019;38(6):601-607. PubMed PMID: 30935897.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial. AU - Hasanin,Ahmed, AU - Amin,Sarah, AU - Refaat,Sherin, AU - Habib,Sara, AU - Zayed,Marwa, AU - Abdelwahab,Yaser, AU - Elsayad,Mohamed, AU - Mostafa,Maha, AU - Raafat,Heba, AU - Elshall,Ahmed, AU - Fatah,Shimaa Abd El, Y1 - 2019/03/30/ PY - 2018/12/18/received PY - 2019/03/18/revised PY - 2019/03/18/accepted PY - 2019/4/3/pubmed PY - 2020/10/6/medline PY - 2019/4/3/entrez KW - Caesarean delivery KW - Norepinephrine KW - Phenylephrine KW - Spinal anaesthesia SP - 601 EP - 607 JF - Anaesthesia, critical care & pain medicine JO - Anaesth Crit Care Pain Med VL - 38 IS - 6 N2 - BACKGROUND: Prophylactic vasopressors are fundamental during caesarean delivery under spinal anaesthesia. The aim of this work is to compare the efficacy and safety of phenylephrine and norepinephrine when used in variable infusion rate during caesarean delivery. METHODS: A randomised, double-blinded, controlled trial was conducted including mothers scheduled for elective caesarean delivery under spinal anaesthesia. Participants were allocated to two groups norepinephrine group (n = 60), and phenylephrine group (n = 63). Participants received prophylactic vasopressors after spinal block at rate started at 0.05 mcg/kg/min and 0.75 mcg/kg/min respectively. The rate of vasopressor infusion was manually adjusted according to maternal systolic blood pressure. Both groups were compared according to incidence of post-spinal hypotension (the primary outcome), incidence of bradycardia, incidence of reactive hypertension, systolic blood pressure, heart rate, rescue vasopressor consumption, number of physician interventions, and neonatal outcomes. RESULTS: One hundred and twenty-three mothers were available for final analysis. Both groups were comparable in the incidence of post-spinal hypotension (32% versus 30%, P = 0.8). The number of physician intervention was lower in norepinephrine group. The incidence of bradycardia and the incidence of reactive hypertension were potentially lower in norepinephrine group without reaching statistical significance, (13% vs. 21%, P = 0.3) and (12% vs. 24%, P = 0.1). Rescue vasopressor consumption, and neonatal outcomes were comparable between both groups. CONCLUSION: When given in a manually adjusted infusion, norepinephrine effectively maintained maternal SBP during caesarean delivery under spinal anaesthesia with lower number of physician interventions, and likely less incidence of reactive hypertension and bradycardia compared to phenylephrine. SN - 2352-5568 UR - https://www.unboundmedicine.com/medline/citation/30935897/Norepinephrine_versus_phenylephrine_infusion_for_prophylaxis_against_post_spinal_anaesthesia_hypotension_during_elective_caesarean_delivery:_A_randomised_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-5568(18)30571-X DB - PRIME DP - Unbound Medicine ER -