Key result
Continuous infusion of phenylephrine at 0.25 μg/kg/min or norepinephrine at 0.05 μg/kg/min significantly reduced the incidence of spinal anesthesia-induced hypotension compared to placebo during cesarean delivery.
Why the study?
Post-spinal anesthesia hypotension during cesarean delivery is common and causes complications, but the effects of norepinephrine compared with traditional phenylephrine infusion remained unclear.
Does continuous infusion of phenylephrine or norepinephrine prevent spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery?
RCT (n=238)
Double-blind
computer-generated randomized numbers
No
Does continuous infusion of phenylephrine or norepinephrine prevent spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery?
Continuous phenylephrine infusion during cesarean delivery effectively prevents spinal anesthesia-induced hypotension while providing better systemic vascular resistance and fetal metabolic profiles compared to norepinephrine or placebo.
May support norepinephrine as phenylephrine alternative in CD; leaves open optimal dosing and fetal outcomes.
Background: Hypotension following spinal anesthesia (SA) during cesarean delivery (CD) occurs commonly and is related with maternal and fetal complications. Norepinephrine infusion is increasingly used for prevention of post-SA hypotension; however, its effects as compared to the traditional phenylephrine infusion remain unclear. This study aimed to compare the effects of phenylephrine and norepinephrine administered as continuous infusion during elective CD on maternal hemodynamic parameters and maternal and fetal outcomes.Methods: This prospective, single-center, randomized, controlled study included 238 consecutive in-term parturients who underwent CD from February 2019 to October 2019. They were randomized to receive continuous infusion of 0.25 μg/kg/min phenylephrine, 0.05 μg/kg/min norepinephrine, or placebo. Hemodynamic monitoring was performed at 10 time points using LiDCOrapid. We analyzed umbilical vein (UV), umbilical artery (UA), and peripheral vein (PV) blood gas indexes and recorded intraoperative complications.Results: In phenylephrine group, the systolic blood pressure (SBP) maintain stable during the whole operation. Compared to the control group, phenylephrine, but not norepinephrine, significantly increased the systemic vascular resistance (SVR) to counteract the SA-induced vasodilatation T4: 957.4±590.3 vs 590.1±273.7 (P<0.000001); T5: 1104±468.0 vs 789.4±376.2 (P=0.000002). T6: 1084±524.8 vs 825.2± 428.6 (P=0.000188). Parturient in the phenylephrine group had significantly lower UV (1.91±0.43) (P=0.0003) and UA (2.05±0.61) (P=0.0038) lactate level compared to controls. Moreover, the UV pH value was higher in the phenylephrine than in the control group7.37±0.03(P=0.0013). Conclusions: Continuous phenylephrine and norepinephrine infusion reduced the incidence of SA-induced maternal hypotension while decreasing overall complications. Phenylephrine infusions are considered the better choice during CD because of the significant benefit to the fetus.
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Feng et al. (2020) conducted an RCT in cesarean delivery under spinal anesthesia (n=238). Phenylephrine vs. Norepinephrine (0.05 μg/kg/min) or Placebo was evaluated on Systolic blood pressure (SBP) at different time points. Continuous infusion of phenylephrine at 0.25 μg/kg/min or norepinephrine at 0.05 μg/kg/min significantly reduced the incidence of spinal anesthesia-induced hypotension compared to placebo during cesarean delivery.
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