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August 22, 2026BMC AnesthesiologyOpen Access

Norepinephrine 0.07 mcg/kg/min proves noninferior to 0.1 mcg/kg/min for maintaining post-spinal MAP in elderly patients.

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Why the study?

The study aimed to compare the hemodynamic response to two norepinephrine infusion rates for prophylaxis against post-spinal hypotension in elderly patients undergoing hip surgery.

Does norepinephrine infusion at 0.07 mcg/kg/min maintain post-spinal MAP non-inferiorly to 0.1 mcg/kg/min in elderly patients undergoing hip surgery under spinal anesthesia?

Population

84 elderly patients undergoing hip surgery under spinal anesthesia

Comparison

Norepinephrine 0.07 mcg/kg/min vs 0.1 mcg/kg/min

Design

Randomized non-inferiority clinical trial

Follow-up

46 min

Key result

A norepinephrine infusion rate of 0.07 mcg/kg/min was noninferior to 0.1 mcg/kg/min in maintaining post-spinal MAP in elderly patients undergoing hip surgery (MD -3.5 mmHg; 95% CI -7.4 to 0.4).

Authors

MWMichael WahibMMMaha MostafaAHAhmed Hasanin

Discussion

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Overview

Lower norepinephrine dose may reduce vasopressor exposure in elderly spinal anesthesia; extends non-inferiority evidence for prophylaxis optimization.

Key Points

  • To compare the hemodynamic efficacy and safety of two norepinephrine infusion rates (0.07 vs. 0.1 mcg/kg/min) for preventing post-spinal hypotension in elderly patients undergoing hip surgery.
  • Randomized non-inferiority clinical trial (NCT07077265) including N=84 elderly patients undergoing hip surgery under spinal anesthesia.
  • Patients received continuous norepinephrine infusions at either 0.1 mcg/kg/min or 0.07 mcg/kg/min, with mean arterial pressure (MAP) and heart rate monitored every 2 minutes for 46 minutes post-anesthesia.
  • The primary endpoint was non-inferiority of post-spinal MAP evaluated against a prespecified margin of -8 mmHg.
  • Average intraoperative MAP was 87.9 ± 9.5 mmHg in the 0.1 mcg/kg/min arm versus 84.5 ± 8.5 mmHg in the 0.07 mcg/kg/min arm (mean difference: -3.5 mmHg; 95% CI: -7.4 to 0.4 mmHg), establishing non-inferiority within the -8 mmHg margin.
  • Incidence of secondary outcomes—including post-spinal hypotension (MAP < 70% of baseline or < 65 mmHg), reactive hypertension, and bradycardia—demonstrated comparable event rates across both dosing groups.

Study Design

Type

RCT (n=84)

Randomization

randomized

Structured PICO

Does norepinephrine infusion at 0.07 mcg/kg/min maintain post-spinal MAP non-inferiorly to 0.1 mcg/kg/min in elderly patients undergoing hip surgery under spinal anesthesia?

P
Population
84 elderly patients scheduled for hip surgery under spinal anesthesia, monitored for 46 minutes post-spinal anesthesia.
I
Intervention
Norepinephrine infusion at a rate of 0.07 mcg/kg/min after spinal anesthesia
C
Comparator
Norepinephrine infusion at a rate of 0.1 mcg/kg/min after spinal anesthesia
O
Outcome
Average mean arterial pressure (MAP) readings over 46 minutes after spinal anesthesia (non-inferiority margin of 8 mmHg)surrogate

Main Result

Mean Difference: -3.5 (95% CI -7.4–0.4)

Absolute Event Rate: 84.5% vs 87.9%

A lower norepinephrine infusion rate of 0.07 mcg/kg/min is non-inferior to 0.1 mcg/kg/min for maintaining mean arterial pressure in elderly patients undergoing hip surgery under spinal anesthesia.

Cite This Study

Wahib et al. (2026) conducted an RCT in post-spinal hypotension in elderly patients undergoing hip surgery (n=84). Norepinephrine infusion vs. 0.1 mcg/kg/min was evaluated on average MAP readings (MD -3.5, 95% CI -7.4 to 0.4). A norepinephrine infusion rate of 0.07 mcg/kg/min was noninferior to 0.1 mcg/kg/min in maintaining post-spinal MAP in elderly patients undergoing hip surgery (MD -3.5 mmHg; 95% CI -7.4 to 0.4).

synapsesocial.com/papers/6a895eaeca7ade938187cc30https://doi.org/10.1186/s12871-026-04174-3
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial2023 · 11 citations
  2. 2Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial2020 · 16 citations
  3. 3Low-Concentration Norepinephrine Infusion for Major Surgery: A Safety and Feasibility Pilot Randomized Controlled Trial2021 · 25 citations
  4. 4Association between continuous low-dose norepinephrine infusion and intraoperative hypotension burden in patients aged 80 years and older undergoing total hip arthroplasty: a retrospective cohort study2026
  5. 5A Comparative Study of Phenylepherine and Norepinephrine Infusion in Prevention of Postspinal Hypotension During Spinal Anesthesia in Non-Obstetric Procedures2022 · 1 citations