Key result
The combination of ephedrine and norepinephrine during spinal anesthesia for cesarean section resulted in significantly lower umbilical cord venous blood pH (7.32) compared to ephedrine (7.38) or norepinephrine (7.41) alone.
Why the study?
Maternal hypotension occurs in up to 90% of Caesarean sections under spinal anesthesia, prompting investigation into the maternal and neonatal effects of combined ephedrine and norepinephrine.
Does the combination of ephedrine and norepinephrine improve maternal hemodynamics and neonatal outcomes in pregnant patients undergoing elective Cesarean section under spinal anesthesia?
RCT (n=90)
Double-blind
Closed envelope method
No
Does the combination of ephedrine and norepinephrine improve maternal hemodynamics and neonatal outcomes in pregnant patients undergoing elective Cesarean section under spinal anesthesia?
The combination of norepinephrine and ephedrine during spinal anesthesia for Cesarean section may increase the risk of fetal acidosis and does not prevent maternal blood pressure decreases as effectively as ephedrine alone.
Combination increases fetal acidosis risk without superior BP control; challenges addition of norepinephrine to ephedrine in cesarean spinal anesthesia.
Objective: The frequency of maternal hypotension after spinal anesthesia in Caesarean section (CS) may be as high as 90%. The aim of this study was to investigate the effect of the use of the combination of ephedrine and norepinephrine on maternal hemodynamics, neonatal APGAR and acidosis in CS delivery under spinal anesthesia. Methods: This prospective, randomized, double-blind study included pregnant patients aged 18 - 45 years, evaluated as ASA class I-II for surgery, who underwent elective CS under spinal anesthesia. The clinical and laboratory findings, umbilical blood gases, maternal blood pressure and heart rate were also analyzed. The patients were randomly separated into 3 groups: Ephedrine (E), Ephedrine+Norepinephrine (EN), and Norepinephrine (N). Results: Umbilical cord venous blood pH and HCO3 was lower in Group EN than the other groups. APGAR score was lower in Group E. Heart rate in Groups EN and N decreased up to the middle of surgery, then was slightly elevated until the end of surgery. Heart rate persistently decreased in Group E from the beginning to the end of the surgery. SBP decreased significantly at the end of the surgery compared to basal levels in Group EN and N, and did not decrease significantly in Group E. Conclusion: These findings suggest that the addition of norepinephrine to ephedrine might increase the risk of fetal acidosis and affect the APGAR score. The longer duration of action and the higher number of bolus of ephedrine might be associated with a lesser decrease in maternal blood pressure after the middle of the surgery.
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Soyalp et al. (2025) conducted an RCT in Maternal hypotension during cesarean section under spinal anesthesia (n=90). Ephedrine and Norepinephrine combination vs. Ephedrine (5 mg) or Norepinephrine (5 mcg) was evaluated on Umbilical cord venous blood pH (p=0.002). The combination of ephedrine and norepinephrine during spinal anesthesia for cesarean section resulted in significantly lower umbilical cord venous blood pH (7.32) compared to ephedrine (7.38) or norepinephrine (7.41) alone.
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