Key result
Bolus doses of norepinephrine significantly reduced the incidence of maternal bradycardia compared to phenylephrine (RR 0.25; 95% CI 0.16-0.39; p<0.01) with comparable neonatal outcomes.
Why the study?
Fetomaternal outcomes comparing norepinephrine versus phenylephrine for post-spinal hypotension in preeclamptic women undergoing cesarean section needed evaluation.
Does norepinephrine improve fetomaternal outcomes and safety compared to phenylephrine in preeclamptic women with post-spinal hypotension undergoing cesarean section?
Meta-Analysis (n=413)
Does norepinephrine improve fetomaternal outcomes and safety compared to phenylephrine in preeclamptic women with post-spinal hypotension undergoing cesarean section?
Relative Risk: 0.25 (95% CI 0.16–0.39)
p-value: p=<0.01
In preeclamptic women undergoing cesarean section, norepinephrine provides superior maternal safety with a lower incidence of bradycardia compared to phenylephrine for treating post-spinal hypotension.
Supports norepinephrine boluses over phenylephrine for cesarean anesthesia; extends Level 1 evidence for vasopressor selection.
OBJECTIVE: We conducted a systematic review and meta-analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section. DATA SOURCES: We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and clinicaltrials.gov from inception till June 2024. STUDY SELECTION: Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane's risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740). RESULTS: A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p < 0.01). There were no statistical differences in other maternal outcomes or in the umbilical artery and umbilical vein blood gas analysis values. We also analyzed adverse events such as nausea (RR = 1.00, 95 % CI: 0.62 to 1.60, p = 1.00) and vomiting (RR = 0.99, 95 % CI: 0.89 to 1.11, p = 0.61), but they did not show a significant association with any group. All the trials had a moderate or low risk of bias. CONCLUSION: Bolus doses of NE and PE for the treatment of post-spinal hypotension in preeclamptic women undergoing cesarean sections were found to exhibit comparable neonatal outcomes. However, NE provided superior maternal safety due to a lower incidence of bradycardia compared to PE.
No takes yet. Share an insight, caveat, or question.
Ahmed et al. (2024) conducted a meta-analysis in Post-spinal hypotension in preeclampsia (n=413). Norepinephrine vs. Phenylephrine was evaluated on Maternal bradycardia (RR 0.25, 95% CI 0.16 to 0.39, p=<0.01). Bolus doses of norepinephrine significantly reduced the incidence of maternal bradycardia compared to phenylephrine (RR 0.25; 95% CI 0.16-0.39; p<0.01) with comparable neonatal outcomes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: