Key result
Norepinephrine was more effective than ephedrine for maintaining systolic blood pressure during spinal anesthesia (80% vs 40%; P<0.0001) in coronary artery disease patients.
Why the study?
Does norepinephrine improve the maintenance of systolic blood pressure compared to ephedrine in coronary artery disease patients undergoing knee arthroscopy under spinal anesthesia?
RCT (n=100)
Double-blind
Randomized
Does norepinephrine improve the maintenance of systolic blood pressure compared to ephedrine in coronary artery disease patients undergoing knee arthroscopy under spinal anesthesia?
Absolute Event Rate: 80% vs 40%
p-value: p=<0.0001
Norepinephrine is more effective than ephedrine for maintaining systolic blood pressure and avoiding tachycardia in patients with coronary artery disease undergoing spinal anesthesia.
Supports norepinephrine over ephedrine for SBP maintenance in CAD patients under spinal anesthesia; extends RCT evidence to this high-risk population.
BackgroundSpinal anesthesia, a popular technique used for lower limb surgery in coronary artery disease patients, could be associated with hypotension, which could be managed with colloids, vasopressor, ephedrine, or norepinephrine (NE).AimThe aim of this study was to assess the efficacy and safety of bolus administration of NE versus ephedrine for the maintenance of systolic blood pressure during spinal anesthesia in coronary artery disease patients undergoing knee arthroscopy.Patients and methodsA randomized, controlled, double-blinded study was carried out on 100 ASA II or III coronary artery disease patients undergoing knee arthroscopy. The patients were divided into two groups of 50 patients each: the ephedrine group (group EPH) and the norepinephrine group (group NE). When hypotension occurred, group EPH received 5 mg of ephedrine and group NE received 5 μg of NE. Systolic blood pressure and heart rate were recorded at 0, 5, 10, 15, 30, and 60 min, and side effects of both drugs were also recorded.ResultsEfficacy was found in 20 (40%) patients of group EPH and in 40 (80%) patients of group NE. The results were highly significant (P < 0.0001). Tachycardia was significantly higher (P < 0.0001) in group EPH. The incidence of hypotension, hypertension, and bradycardia was not significantly different between the two groups.ConclusionNE is more effective compared with ephedrine in the maintenance of systolic blood pressure with reduction in heart rate, which is useful in coronary artery disease patients undergoing knee arthroscopy under spinal anesthesia in whom tachycardia is undesirable.
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Fawy et al. (2015) conducted an RCT in Coronary artery disease undergoing knee arthroscopy (n=100). Norepinephrine vs. Ephedrine was evaluated on Efficacy (maintenance of systolic blood pressure) (p=<0.0001). Norepinephrine was more effective than ephedrine for maintaining systolic blood pressure during spinal anesthesia (80% vs 40%; P<0.0001) in coronary artery disease patients.
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