Key result
Bolus norepinephrine resulted in an overall heart rate of 80.5 bpm compared to 76.6 bpm with phenylephrine (P=0.04) and 84.9 bpm with ephedrine (P=0.02), with fewer episodes of bradycardia.
Why the study?
The study aimed to compare the efficacy and safety of bolus norepinephrine, phenylephrine, and ephedrine in parturients with preeclampsia who experienced hypotension during cesarean delivery under spinal anesthesia.
Does bolus norepinephrine improve overall SBP and HR compared to phenylephrine and ephedrine in parturient women with preeclampsia experiencing hypotension during cesarean delivery under spinal anesthesia?
RCT (n=166)
Does bolus norepinephrine improve overall SBP and HR compared to phenylephrine and ephedrine in parturient women with preeclampsia experiencing hypotension during cesarean delivery under spinal anesthesia?
Absolute Event Rate: 80.5% vs 76.6%
p-value: p=0.04
Bolus norepinephrine provides similar efficacy to phenylephrine but with a more stable heart rate profile (less bradycardia than phenylephrine and less tachycardia than ephedrine) for treating hypotension in preeclamptic women during cesarean delivery.
May support norepinephrine for intermediate HR stability in preeclamptic cesarean hypotension; leaves open confirmation in larger trials before practice change.
BACKGROUND This study aimed to compare the efficacy and safety of bolus norepinephrine, phenylephrine, and ephedrine in parturient with preeclampsia who had hypotension during cesarean delivery under spinal anesthesia. MATERIAL AND METHODS One hundred and sixty-six parturient women with preeclampsia who had a baseline systolic blood pressure (SBP) <80% during spinal anesthesia for cesarean section were divided into three treatment groups; bolus norepinephrine 4 μg (group N) (n=56), phenylephrine 50 μg (group P) (n=55), and ephedrine 4 mg (group E) (n=55). Primary outcomes included overall SBP and heart rate (HR) until delivery. Secondary outcomes included the incidence of tachycardia (HR >120 bpm), bradycardia (HR <60 bpm), hypertension (SBP >120% baseline), number of boluses of vasopressor required and episodes of hypotension, maternal side effects, and neonatal outcome. RESULTS Overall HR in group N was significantly increased compared with group P (80.5±12 vs. 76.6±6.9 bpm; P=0.04), and significantly lower compared with group E (80.5±12 vs. 84.9±7.1 bpm; P=0.02). Parturients in group N had fewer episodes of bradycardia compared with group P (3.6% vs. 21.8%; RR=0.26l; 95% CI, 0.07-0.73; P=0.004) and fewer episodes of tachycardia compared with group E (16.1% vs. 36.4%; RR 0.54; 95% CI, 0.29-0.90; P=0.02). CONCLUSIONS A bolus dose of norepinephrine showed similar efficacy to phenylephrine but improved maternal and neonatal safety in parturients with preeclampsia with hypotension during cesarean section under spinal anesthesia.
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Wang et al. (2019) conducted an RCT in Preeclampsia with hypotension during cesarean delivery under spinal anesthesia (n=166). Norepinephrine vs. Phenylephrine (50 μg) and Ephedrine (4 mg) was evaluated on Overall SBP and heart rate (HR) until delivery (p=0.04). Bolus norepinephrine resulted in an overall heart rate of 80.5 bpm compared to 76.6 bpm with phenylephrine (P=0.04) and 84.9 bpm with ephedrine (P=0.02), with fewer episodes of bradycardia.
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