Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial - 13/04/19

Doi : 10.1016/j.accpm.2019.03.005

Ahmed Hasanin ^a,^⁎ , Sarah Amin ^a , Sherin Refaat ^a , Sara Habib ^a , Marwa Zayed ^a , Yaser abdelwahab ^a , Mohamed Elsayad ^a , Maha Mostafa ^a , Heba Raafat ^a , Ahmed Elshall ^a , Shimaa Abd El Fatah ^b
^a Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt
^b Department of obstetrics and gynaecology, Cairo university, Cairo, Egypt

^⁎Corresponding author at: Cairo university, Department of anaesthesia and critical care medicine, faculty of medicine, 01, elsarayah street, Elmanyal, Cairo 11559, Egypt.Cairo university, Department of anaesthesia and critical care medicine, faculty of medicine01, elsarayah street, ElmanyalCairo11559Egypt

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Highlights

•	Prophylactic vasopressors are advised in caesarean delivery under spinal anaesthesia.
•	Norepinephrine and phenylephrine effectively controlled maternal blood pressure.
•	Lower number of physician interventions was noticed in norepinephrine group.
•	Reactive hypertension incidence was potentially lower in norepinephrine group.
•	Also, the incidence of bradycardia was potentially lower in norepinephrine group.

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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.

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Keywords : Phenylephrine, Norepinephrine, Caesarean delivery, Spinal anaesthesia