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A systematic review of phenylephrine vs. noradrenaline for the management of hypotension associated with neuraxial anaesthesia in women undergoing caesarean section.
Anaesthesia. 2020 06; 75(6):800-808.A

Abstract

Phenylephrine is recommended for the management of hypotension after spinal anaesthesia in women undergoing caesarean section. Noradrenaline, an adrenergic agonist with weak β-adrenergic activity, has been reported to have a more favourable haemodynamic profile than phenylephrine. However, there are concerns that noradrenaline may be associated with a higher risk of fetal acidosis, defined as an umbilical artery pH < 7.20. We performed a systematic review of trials comparing noradrenaline with phenylephrine, concentrating on primary outcomes of fetal acidosis and maternal hypotension. We identified 13 randomised controlled trials including 2002 patients. Heterogeneity among the studies was high, and there were too few data to calculate a pooled effect estimate. Fetal acidosis was assessed in four studies that had a low risk of bias and a low risk of confounding, that is, studies which used a prophylactic vasopressor and where women received the allocated vasopressor only. There were no significant differences between these studies. No significant differences were observed for hypotension. Two trials found a significantly lower incidence of bradycardia when using noradrenaline. Cardiac output was significantly higher after noradrenaline in two of three studies. For other secondary outcomes including nausea, vomiting and Apgar scores at 1 and 5 min, no studies found significant differences. The evidence so far is too limited to support an advantage of noradrenaline over phenylephrine. Concerns of a deleterious effect of noradrenaline on fetal blood gas status cannot currently be assuaged by the available data from randomised controlled studies.

Authors+Show Affiliations

Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland.Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland.Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands.Department of Anaesthesia, University Hospital RWTH Aachen, Aachen, Germany.Department of Anaesthesia, University Hospital Basel, Basel, Switzerland.Department of Anaesthesia, A. Béclère Hospital - APHP & Paris-Saclay University, Clamart, France.Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

32012226

Citation

Heesen, M, et al. "A Systematic Review of Phenylephrine Vs. Noradrenaline for the Management of Hypotension Associated With Neuraxial Anaesthesia in Women Undergoing Caesarean Section." Anaesthesia, vol. 75, no. 6, 2020, pp. 800-808.
Heesen M, Hilber N, Rijs K, et al. A systematic review of phenylephrine vs. noradrenaline for the management of hypotension associated with neuraxial anaesthesia in women undergoing caesarean section. Anaesthesia. 2020;75(6):800-808.
Heesen, M., Hilber, N., Rijs, K., Rossaint, R., Girard, T., Mercier, F. J., & Klimek, M. (2020). A systematic review of phenylephrine vs. noradrenaline for the management of hypotension associated with neuraxial anaesthesia in women undergoing caesarean section. Anaesthesia, 75(6), 800-808. https://doi.org/10.1111/anae.14976
Heesen M, et al. A Systematic Review of Phenylephrine Vs. Noradrenaline for the Management of Hypotension Associated With Neuraxial Anaesthesia in Women Undergoing Caesarean Section. Anaesthesia. 2020;75(6):800-808. PubMed PMID: 32012226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review of phenylephrine vs. noradrenaline for the management of hypotension associated with neuraxial anaesthesia in women undergoing caesarean section. AU - Heesen,M, AU - Hilber,N, AU - Rijs,K, AU - Rossaint,R, AU - Girard,T, AU - Mercier,F J, AU - Klimek,M, Y1 - 2020/02/03/ PY - 2019/11/23/accepted PY - 2020/2/6/pubmed PY - 2020/6/25/medline PY - 2020/2/4/entrez KW - anaesthesia, spinal KW - caesarean section KW - noradrenaline KW - phenylephrine KW - systematic review SP - 800 EP - 808 JF - Anaesthesia JO - Anaesthesia VL - 75 IS - 6 N2 - Phenylephrine is recommended for the management of hypotension after spinal anaesthesia in women undergoing caesarean section. Noradrenaline, an adrenergic agonist with weak β-adrenergic activity, has been reported to have a more favourable haemodynamic profile than phenylephrine. However, there are concerns that noradrenaline may be associated with a higher risk of fetal acidosis, defined as an umbilical artery pH < 7.20. We performed a systematic review of trials comparing noradrenaline with phenylephrine, concentrating on primary outcomes of fetal acidosis and maternal hypotension. We identified 13 randomised controlled trials including 2002 patients. Heterogeneity among the studies was high, and there were too few data to calculate a pooled effect estimate. Fetal acidosis was assessed in four studies that had a low risk of bias and a low risk of confounding, that is, studies which used a prophylactic vasopressor and where women received the allocated vasopressor only. There were no significant differences between these studies. No significant differences were observed for hypotension. Two trials found a significantly lower incidence of bradycardia when using noradrenaline. Cardiac output was significantly higher after noradrenaline in two of three studies. For other secondary outcomes including nausea, vomiting and Apgar scores at 1 and 5 min, no studies found significant differences. The evidence so far is too limited to support an advantage of noradrenaline over phenylephrine. Concerns of a deleterious effect of noradrenaline on fetal blood gas status cannot currently be assuaged by the available data from randomised controlled studies. SN - 1365-2044 UR - https://www.unboundmedicine.com/medline/citation/32012226/A_systematic_review_of_phenylephrine_vs__noradrenaline_for_the_management_of_hypotension_associated_with_neuraxial_anaesthesia_in_women_undergoing_caesarean_section_ L2 - https://doi.org/10.1111/anae.14976 DB - PRIME DP - Unbound Medicine ER -