What is the clinical evidence from this study?

Study design: RCT. Population: Maternal hypotension during elective cesarean section with spinal anesthesia (n=102). Intervention: Norepinephrine vs. Phenylephrine 100 mg bolus. Primary outcome: Standardized maternal cardiac output (CO) from spinal anesthesia until delivery (p=0.02).

January 28, 2020Chinese Medical JournalOpen Access

Bolus norepinephrine and phenylephrine for maternal hypotension during elective cesarean section with spinal anesthesia: a randomized, double-blinded study

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Key result

Intermittent bolus norepinephrine provided a significantly greater standardized maternal cardiac output compared to phenylephrine (5.8 vs. 5.3 L/min, P=0.02) during elective cesarean section with spinal anesthesia.

Why the study?

Intermittent bolus is widely used for obstetric vasopressors in China, motivating a comparison of the efficacy and safety of equivalent bolus norepinephrine and phenylephrine for maternal post-spinal hypotension.

Does intermittent bolus norepinephrine improve maternal cardiac output compared to phenylephrine during elective cesarean section with spinal anesthesia?

Population

102 women undergoing elective cesarean section with spinal anesthesia in China

Comparison

Prophylactic and rescue bolus norepinephrine vs phenylephrine

Design

Randomized, double-blinded study

Follow-up

From spinal anesthesia until delivery

Authors

XWXian WangAnhui Provincial Hospital MMMao MaoBGI Group (China)SZSusu ZhangShenyang Pharmaceutical University

Discussion

Member takes

Implication

Norepinephrine may be preferred to phenylephrine for spinal anesthesia in cesarean delivery; extends comparative hemodynamic data in obstetric RCTs.

Study Design

Type

RCT (n=102)

Blinding

Double-blind

Randomization

Computer derived randomized number

Multicenter

Structured PICO

Does intermittent bolus norepinephrine improve maternal cardiac output compared to phenylephrine during elective cesarean section with spinal anesthesia?

Population

102 primiparous women aged 18-45 years undergoing elective cesarean section with spinal anesthesia, randomized to receive bolus norepinephrine or phenylephrine and followed until delivery.

Intervention

Prophylactic 8 μg norepinephrine bolus immediately post-spinal anesthesia, followed by extra boluses of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80% of baseline.

Comparator

Prophylactic 100 μg phenylephrine bolus immediately post-spinal anesthesia, followed by extra boluses of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80% of baseline.

Outcome

Standardized maternal cardiac output (CO) reading from spinal anesthesia until delivery analyzed by a two-step method.surrogate

Main Result

Absolute Event Rate: 5.8% vs 5.3%

p-value: p=0.02

Intermittent bolus norepinephrine provides greater maternal cardiac output and less bradycardia than phenylephrine during elective cesarean section with spinal anesthesia, though without obvious clinical advantages.

Limitations

Absence of obvious clinical advantages questions the clinical significance of the observed cardiac output superiority.
Did not evaluate conditions where uteroplacental perfusion is restricted, such as fetal compromise or preeclampsia.
Differences in cardiovascular function detection methods (NICOM) compared to previous studies may affect comparability.

Cite This Study

Wang et al. (2020) conducted an RCT in Maternal hypotension during elective cesarean section with spinal anesthesia (n=102). Norepinephrine vs. Phenylephrine 100 mg bolus was evaluated on Standardized maternal cardiac output (CO) from spinal anesthesia until delivery (p=0.02). Intermittent bolus norepinephrine provided a significantly greater standardized maternal cardiac output compared to phenylephrine (5.8 vs. 5.3 L/min, P=0.02) during elective cesarean section with spinal anesthesia.

synapsesocial.com/papers/6a9626e8e2c87aea1dd22b29 https://doi.org/10.1097/cm9.0000000000000621

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Implication

Norepinephrine may be preferred to phenylephrine for spinal anesthesia in cesarean delivery; extends comparative hemodynamic data in obstetric RCTs.

Bolus norepinephrine and phenylephrine for maternal hypotension during elective cesarean section with spinal anesthesia: a randomized, double-blinded study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Bolus norepinephrine and phenylephrine for maternal hypotension during elective cesarean section with spinal anesthesia: a randomized, double-blinded study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider