January 1, 2018Anesthesia Essays and Researches

Norepinephrine versus ephedrine to maintain arterial blood pressure during spinal anesthesia for cesarean delivery: A prospective double-blinded trial

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Spinal hypotension during cesarean delivery (n=122). Intervention: Norepinephrine vs. Ephedrine (10 mg prophylactic i.v. bolus plus 10 mg rescue boluses). Primary outcome: Number of boluses of vasopressors used (p=0.005).

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Key result

Norepinephrine significantly reduced the median number of vasopressor boluses required to maintain maternal blood pressure compared to ephedrine (2 vs 3 boluses, P=0.005) during spinal anesthesia for cesarean delivery.

Why the study?

Does norepinephrine reduce the number of vasopressor boluses and improve hemodynamic stability compared to ephedrine in healthy women undergoing elective cesarean delivery under spinal anesthesia?

Population

122 healthy women with singleton pregnancies at term scheduled for elective cesarean section under spinal…

Comparison

Norepinephrine 5 μg i.v. prophylactic bolus at… vs Ephedrine 10 mg i.v. prophylactic bolus at the…

Design

RCT, 122 slips labeled with either norepinephrine or ephedrine were sealed…

Follow-up

Until the end of surgery

Authors

AEAli Mohamed Ali ElnabtityZagazig University MSMohamed Foad SelimZagazig University

Discussion

Member takes

Implication

Norepinephrine may be preferred over ephedrine for BP management in cesarean spinal anesthesia; extends RCT evidence for its use as an alternative vasopressor.

Study Design

Type

RCT (n=122)

Blinding

Double-blind

Randomization

Sealed slips in a container

Multicenter

Structured PICO

Does norepinephrine reduce the number of vasopressor boluses and improve hemodynamic stability compared to ephedrine in healthy women undergoing elective cesarean delivery under spinal anesthesia?

Population

122 healthy women (ASA I-II) with singleton pregnancies at term undergoing elective cesarean delivery under spinal anesthesia, followed until the end of surgery.

Intervention

Norepinephrine 5 μg i.v. prophylactic bolus at the time of intrathecal block, plus rescue boluses of 5 μg i.v. as required to maintain systolic blood pressure (when SBP dropped by ≥20% from baseline).

Comparator

Ephedrine 10 mg i.v. prophylactic bolus at the time of intrathecal block, plus rescue boluses of 10 mg i.v. as required to maintain systolic blood pressure (when SBP dropped by ≥20% from baseline).

Outcome

Number of boluses of vasopressors used.surrogate

Main Result

Absolute Event Rate: 2% vs 3%

p-value: p=0.005

Norepinephrine is a suitable and potent alternative to ephedrine for counterbalancing the hemodynamic effects of spinal anesthesia during cesarean delivery, requiring fewer vasopressor boluses and causing less tachycardia.

Limitations

Follow-up extended only until the end of surgery, lacking long-term postoperative data until discharge.
Follow-up extended only until the end of surgery
Lack of long-term follow-up in the postoperative period till discharge of the patients to home

Cite This Study

Elnabtity et al. (2018) conducted an RCT in Spinal hypotension during cesarean delivery (n=122). Norepinephrine vs. Ephedrine (10 mg prophylactic i.v. bolus plus 10 mg rescue boluses) was evaluated on Number of boluses of vasopressors used (p=0.005). Norepinephrine significantly reduced the median number of vasopressor boluses required to maintain maternal blood pressure compared to ephedrine (2 vs 3 boluses, P=0.005) during spinal anesthesia for cesarean delivery.

synapsesocial.com/papers/6a88435d8dfe8b7ec5a54062 https://doi.org/10.4103/aer.aer_204_17

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Implication

Norepinephrine may be preferred over ephedrine for BP management in cesarean spinal anesthesia; extends RCT evidence for its use as an alternative vasopressor.

Norepinephrine versus ephedrine to maintain arterial blood pressure during spinal anesthesia for cesarean delivery: A prospective double-blinded trial

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Norepinephrine versus ephedrine to maintain arterial blood pressure during spinal anesthesia for cesarean delivery: A prospective double-blinded trial

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider