Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial.
Adolescent
Adult
Anesthesia, Spinal
/ adverse effects
Bradycardia
/ epidemiology
Cesarean Section
Double-Blind Method
Elective Surgical Procedures
Female
Humans
Hypertension
/ epidemiology
Hypotension
/ epidemiology
Incidence
Infant, Newborn
Infusions, Intravenous
Intraoperative Complications
/ epidemiology
Monitoring, Intraoperative
Norepinephrine
/ administration & dosage
Phenylephrine
/ administration & dosage
Postoperative Nausea and Vomiting
/ etiology
Pregnancy
Vasoconstrictor Agents
/ administration & dosage
Young Adult
Caesarean delivery
Norepinephrine
Phenylephrine
Spinal anaesthesia
Journal
Anaesthesia, critical care & pain medicine
ISSN: 2352-5568
Titre abrégé: Anaesth Crit Care Pain Med
Pays: France
ID NLM: 101652401
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
18
12
2018
revised:
18
03
2019
accepted:
18
03
2019
pubmed:
3
4
2019
medline:
6
10
2020
entrez:
3
4
2019
Statut:
ppublish
Résumé
Prophylactic vasopressors are fundamental during caesarean delivery under spinal anaesthesia. The aim of this work is to compare the efficacy and safety of phenylephrine and norepinephrine when used in variable infusion rate during caesarean delivery. A randomised, double-blinded, controlled trial was conducted including mothers scheduled for elective caesarean delivery under spinal anaesthesia. Participants were allocated to two groups norepinephrine group (n = 60), and phenylephrine group (n = 63). Participants received prophylactic vasopressors after spinal block at rate started at 0.05 mcg/kg/min and 0.75 mcg/kg/min respectively. The rate of vasopressor infusion was manually adjusted according to maternal systolic blood pressure. Both groups were compared according to incidence of post-spinal hypotension (the primary outcome), incidence of bradycardia, incidence of reactive hypertension, systolic blood pressure, heart rate, rescue vasopressor consumption, number of physician interventions, and neonatal outcomes. One hundred and twenty-three mothers were available for final analysis. Both groups were comparable in the incidence of post-spinal hypotension (32% versus 30%, P = 0.8). The number of physician intervention was lower in norepinephrine group. The incidence of bradycardia and the incidence of reactive hypertension were potentially lower in norepinephrine group without reaching statistical significance, (13% vs. 21%, P = 0.3) and (12% vs. 24%, P = 0.1). Rescue vasopressor consumption, and neonatal outcomes were comparable between both groups. When given in a manually adjusted infusion, norepinephrine effectively maintained maternal SBP during caesarean delivery under spinal anaesthesia with lower number of physician interventions, and likely less incidence of reactive hypertension and bradycardia compared to phenylephrine.
Sections du résumé
BACKGROUND
Prophylactic vasopressors are fundamental during caesarean delivery under spinal anaesthesia. The aim of this work is to compare the efficacy and safety of phenylephrine and norepinephrine when used in variable infusion rate during caesarean delivery.
METHODS
A randomised, double-blinded, controlled trial was conducted including mothers scheduled for elective caesarean delivery under spinal anaesthesia. Participants were allocated to two groups norepinephrine group (n = 60), and phenylephrine group (n = 63). Participants received prophylactic vasopressors after spinal block at rate started at 0.05 mcg/kg/min and 0.75 mcg/kg/min respectively. The rate of vasopressor infusion was manually adjusted according to maternal systolic blood pressure. Both groups were compared according to incidence of post-spinal hypotension (the primary outcome), incidence of bradycardia, incidence of reactive hypertension, systolic blood pressure, heart rate, rescue vasopressor consumption, number of physician interventions, and neonatal outcomes.
RESULTS
One hundred and twenty-three mothers were available for final analysis. Both groups were comparable in the incidence of post-spinal hypotension (32% versus 30%, P = 0.8). The number of physician intervention was lower in norepinephrine group. The incidence of bradycardia and the incidence of reactive hypertension were potentially lower in norepinephrine group without reaching statistical significance, (13% vs. 21%, P = 0.3) and (12% vs. 24%, P = 0.1). Rescue vasopressor consumption, and neonatal outcomes were comparable between both groups.
CONCLUSION
When given in a manually adjusted infusion, norepinephrine effectively maintained maternal SBP during caesarean delivery under spinal anaesthesia with lower number of physician interventions, and likely less incidence of reactive hypertension and bradycardia compared to phenylephrine.
Identifiants
pubmed: 30935897
pii: S2352-5568(18)30571-X
doi: 10.1016/j.accpm.2019.03.005
pii:
doi:
Substances chimiques
Vasoconstrictor Agents
0
Phenylephrine
1WS297W6MV
Norepinephrine
X4W3ENH1CV
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
601-607Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.