Manually Controlled, Continuous Infusion of Phenylephrine or Norepinephrine for Maintenance of Blood Pressure and Cardiac Output During Spinal Anesthesia for Cesarean Delivery: A Double-Blinded Randomized Study
Authors' conclusion
When administered by manually adjusted infusion during SA for cesarean delivery, norepinephrine was associated with a higher CI; both infusions were effective for maintaining BP.
Study context
- Population
- Parturients scheduled for elective cesarean delivery under spinal anesthesia, tertiary maternity in France, February 2019–December 2020
- Participants
- 124 participants
- Comparison
- Norepinephrine vs phenylephrine by manually adjusted continuous infusion
- Norepinephrinen = 62
- Phenylephrinen = 62reference
- Primary endpoint
- Change in cardiac index measured by thoracic bioreactance
- Follow-up
- From SA to umbilical cord clamping
Methodological detailspragmatic, parallel-group, double-blind
- Pragmatic
- Parallel-group
- Double-blind
Primary result
As reported in the abstract
Cardiac index (% of baseline)
Norepinephrine
90% and 100%
% of baseline
Phenylephrine
81%-88%
% of baseline
P = 0.001
Secondary outcomes
| Outcome | Norepinephrine | Phenylephrine | Absolute risk difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Percentage of elapsed time with mean maternal BP <65 mm Hg | 0.5% (SD 1.8) | 2.9% (SD 7.3) | −2.4% (−4.4 to −0.5) | P = 0.012 | |
| Percentage of elapsed time with SBP <80% of baseline | 2.3% (SD 5.2) | 8.5% (SD 16.6) | −6.2% (−10.6 to −1.8) | P = 0.006 | |
| −15−10−505Difference (linear scale) |
Other neonatal outcomes
- Did not differ significantly between the groups
Safety
Severe neonatal hypoglycemia (excluding parturients with gestational diabetes)
P = 0.02
- Severe neonatal hypoglycemia (excluding parturients with gestational diabetes): 9/46 vs 2/49
Original publication
Manually Controlled, Continuous Infusion of Phenylephrine or Norepinephrine for Maintenance of Blood Pressure and Cardiac Output During Spinal Anesthesia for Cesarean Delivery: A Double-Blinded Randomized Study. Anesth Analg. Published 24 October 2022. doi:10.
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