Key result
Norepinephrine and phenylephrine infusions demonstrated similar efficacy in preventing hypotension during spinal anesthesia for cesarean delivery, with no significant differences in mean systolic blood pressure (P=0.65).
Why the study?
Hypotension following spinal anesthesia is a common complication of cesarean delivery with maternal and fetal risks, prompting a comparison of norepinephrine versus phenylephrine infusion for its prevention.
Does norepinephrine infusion prevent hypotension as effectively as phenylephrine infusion in pregnant women undergoing cesarean section under spinal anesthesia?
RCT (n=90)
Double-blind
Stratified block randomization
No
Does norepinephrine infusion prevent hypotension as effectively as phenylephrine infusion in pregnant women undergoing cesarean section under spinal anesthesia?
Absolute Event Rate: 123.1% vs 119.5%
p-value: p=0.65
Norepinephrine and phenylephrine demonstrate similar efficacy in preventing hypotension during spinal anesthesia for cesarean delivery.
Both agents show equivalent efficacy in this RCT; reinforces consensus for flexible vasopressor selection in cesarean anesthesia.
Background: Hypotension following spinal anesthesia is one of the most common complications of cesarean delivery, posing significant risks to both maternal and fetal health. The use of vasopressors is a primary method for the prevention and management of hypotension. Objective: This study aimed to compare the efficacy of norepinephrine and phenylephrine infusion in preventing hypotension in patients undergoing cesarean section under spinal anesthesia. Methods: In this randomized, double-blind clinical trial, 90 pregnant women at 37 weeks of gestation scheduled for elective cesarean delivery were randomly assigned to receive either norepinephrine (n=47) or phenylephrine (n=43). The initial infusion rate was set at 5 µg/min for norepinephrine (up to a maximum of 60 mL/min) and 0.5 mg/min for phenylephrine (up to a maximum of 60 mL/min). Hemodynamic parameters, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate, were assessed. Additionally, umbilical cord blood gas values (PACO2 and pH) at the time of birth were measured. Statistical analysis was performed using SPSS version 18 with descriptive statistics and independent t-tests or Mann-Whitney U tests (P≤0.05). Results: The findings revealed no statistically significant differences between the norepinephrine and phenylephrine groups regarding SBP and DBP, MAP, heart rate, and umbilical cord blood gas values (PACO2 and pH) at delivery (P≥0.05). Conclusion: Norepinephrine and phenylephrine appear to have similar efficacy in preventing hypotension during cesarean delivery. Clinicians may select either drug based on the patient’s clinical conditions and preferences.
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Jalili et al. (2025) conducted an RCT in Hypotension during spinal anesthesia for cesarean delivery (n=90). Norepinephrine vs. Phenylephrine 0.5 mg/min was evaluated on Mean systolic blood pressure (p=0.65). Norepinephrine and phenylephrine infusions demonstrated similar efficacy in preventing hypotension during spinal anesthesia for cesarean delivery, with no significant differences in mean systolic blood pressure (P=0.65).
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