Key result
Norepinephrine matches phenylephrine for spinal hypotension but cuts bradycardia by ~30 percentage points.
Why the study?
Hypotension following spinal anesthesia in cesarean sections can reduce maternal cardiac output and placental blood flow, prompting a comparison of the hemodynamic effects of norepinephrine versus phenylephrine.
Does norepinephrine improve maternal hemodynamic stability and prevent hypotension better than phenylephrine in pregnant women undergoing elective cesarean section under spinal anesthesia?
RCT (n=52)
Single-blind
Permuted blocks of size 4
No
Does norepinephrine improve maternal hemodynamic stability and prevent hypotension better than phenylephrine in pregnant women undergoing elective cesarean section under spinal anesthesia?
Norepinephrine is as effective as phenylephrine for preventing hypotension during spinal anesthesia for cesarean section, but offers the significant advantage of reducing the incidence of maternal bradycardia.
Norepinephrine may be preferred over phenylephrine for spinal anesthesia hypotension in cesarean delivery to reduce bradycardia; extends RCT evidence supporting its hemodynamic profile.
Background: Hypotension after spinal anesthesia is a serious complication during cesarean sections, potentially reducing maternal cardiac output and placental blood flow, affecting both mother and baby. This study aimed to compare the effects of norepinephrine and phenylephrine on maternal hemodynamic changes following spinal anesthesia in elective cesarean surgeries. Methods: In this clinical trial study, 52 pregnant mothers' candidates for elective cesarean surgery were divided into two groups. After spinal anesthesia, the norepinephrine group received a 10-microgram bolus of norepinephrine, while the phenylephrine group received 100 micrograms of phenylephrine. The primary outcomes included blood pressure, heart rate, and measurement time. These were recorded three times before the start of spinal anesthesia, immediately after, and every 3 minutes until discharge, and then twice at 3-minute intervals after childbirth. Results: Mean arterial pressure in norepinephrine group was always higher than phenylephrine. Their difference was significant at the ninth minute (p<0.001) and the twelfth minute (P=0.009). Diastolic pressure in the two studied groups was significant at the ninth minute (p<0.001). 2 patients in norepinephrine group (7.6%) and 6 (23%)patients in phenylephrine group needed vasopressor. 3.8% of patients in norepinephrine group and 34% of patients in phenylephrine group had bradycardia (P=0.020). Conclusion: This study shows that norepinephrine is as effective as phenylephrine in preventing blood pressure drop in patients undergoing cesarean section, but it does not cause bradycardia.
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Banihashem et al. (2026) conducted an RCT in Hypotension after spinal anesthesia during cesarean section (n=52). Norepinephrine vs. Phenylephrine 100-microgram bolus was evaluated on Mean arterial pressure at 9 minutes after start of anesthesia (p=<0.001). Norepinephrine is as effective as phenylephrine in preventing blood pressure drop during cesarean section under spinal anesthesia, but causes a significantly lower incidence of bradycardia (3.8% vs 34%).
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