Key result
Prophylactic fixed-rate norepinephrine infusion increased the proportion of patients requiring no rescue phenylephrine boluses compared to phenylephrine infusion during cesarean delivery.
Why the study?
Although phenylephrine is recommended to treat spinal hypotension during cesarean delivery, the comparative role of prophylactic norepinephrine infusions needed evaluation.
Does prophylactic norepinephrine infusion reduce the requirement for rescue phenylephrine boluses compared to prophylactic phenylephrine infusion in pregnant women undergoing elective cesarean delivery under spinal anesthesia?
RCT (n=208)
Double-blind
Computer-generated randomization codes placed in sealed and sequentially numbered envelopes
No
Does prophylactic norepinephrine infusion reduce the requirement for rescue phenylephrine boluses compared to prophylactic phenylephrine infusion in pregnant women undergoing elective cesarean delivery under spinal anesthesia?
Prophylactic fixed-rate norepinephrine infusion during cesarean delivery under spinal anesthesia significantly reduces the need for rescue vasopressor boluses compared to phenylephrine, with a similar neonatal safety profile.
Answers are grounded in this paper and cite their sources.
Prophylactic vasopressor infusion may aid hemodynamic stability in cesarean delivery; hypothesis-generating and should not yet change practice.
Background Maternal hypotension following spinal anesthesia can be actively countered by the use of vasopressors. Prophylactic infusion of vasopressors with a rescue bolus dosing was observed to be more effective for hemodynamic stability when compared to administering a bolus dose alone. Although phenylephrine is the recommended drug to treat spinal hypotension, many recent studies have focussed on the role of norepinephrine infusions during cesarean section. In this study, we compared prophylactic fixed-rate intravenous infusions of phenylephrine and norepinephrine during cesarean delivery under spinal anesthesia and the requirement of intraoperative provider-administered rescue bolus of phenylephrine needed to overcome post-spinal anesthesia hypotension. Methodology A total of 208 patients undergoing elective cesarean section under spinal anesthesia were randomly assigned to two groups (group P and group N). Group N included 104 patients who received norepinephrine infusion at a rate of 2.5 μg/minute (0.04 μg/kg/minute), and group P included 104 patients who received phenylephrine infusion at a rate of 50 μg/minute (0.8 μg/kg/minute) to treat spinal hypotension. The primary outcome of our study was to compare the reduction in the number and total dose of intraoperative provider-administered rescue bolus of phenylephrine needed to maintain systolic blood pressure. The secondary outcome of our study was to compare the neonatal outcome using umbilical venous blood gas sampling and Apgar score at one and five minutes. Results The total number of phenylephrine rescue bolus required to treat hypotension was significantly lower in group N (p = 0.0005) compared to group P. The neonatal outcome was similar between the two groups. Conclusions Prophylactic norepinephrine infusion when compared to prophylactic phenylephrine infusion is associated with a lesser requirement of rescue phenylephrine boluses.
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Arthi et al. (2023) conducted an RCT in Post-spinal anesthesia hypotension (n=208). Norepinephrine infusion vs. Phenylephrine infusion (50 μg/minute) was evaluated on Proportion of patients requiring no intraoperative rescue bolus of phenylephrine to maintain systolic blood pressure (p=0.0005). Prophylactic fixed-rate norepinephrine infusion increased the proportion of patients requiring no rescue phenylephrine boluses compared to phenylephrine infusion during cesarean delivery.
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