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Norepinephrine prophylaxis for postspinal anesthesia hypotension in parturient undergoing cesarean section: a randomized, controlled trial

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To investigate the efficacy and safety of prophylactic infusion of norepinephrine (NE) versus normal saline in patients undergoing cesarean section.

Methods

Patients (n = 97) were randomized to receive a bolus of NE (6 μg) immediately following spinal anesthesia with maintenance NE (0.05 μg/kg/min IV) or normal saline (n = 98). The primary endpoint was the incidence of postspinal anesthesia hypotension [systolic blood pressure (SBP) < 80% of baseline] at 1–20 min following spinal anesthesia. Secondary outcomes were the overall stability of SBP control versus baseline, inferior vena cava collapsibility index (IVC-CI), other adverse events (bradycardia, nausea, vomiting, and hypertension), and neonatal outcomes (blood gas values and Apgar scores).

Results

The rates of postspinal anesthesia hypotension and severe postspinal anesthesia hypotension (SBP < 60% of the baseline) were significantly lower in the NE group (17.5% vs. 62.2%, p < 0.001; 7.2% vs. 17.4%, p = 0.031). In the NE group, SBP remained more stable and closer to baseline (p < 0.001), and IVC-CI values were lower 5 min after spinal anesthesia and 5 min after fetal delivery (p = 0.045; p < 0.001, respectively). Other adverse effects and neonatal outcomes were not different between the two groups.

Conclusion

Prophylactic NE infusion effectively lowers the incidence of postspinal anesthesia hypotension and does not increase other adverse events in patients or neonates.

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Funding

This work was funded by National Natural Science Foundation of China (Grant Number: 81660229, 81860213) and Ningxia Personnel Training Project (Grant Number: KJT2015017), Yinchuan, China.

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Author notes

  1. Yi Chen, Lei Guo and Yongqiang Shi contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, 750004, Ningxia, China

    Yi Chen, Lei Guo, Yongqiang Shi, Gang Ma & Xinli Ni

  2. Department of Obstetrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China

    Wei Xue, Ling He & Shuqin Ma

Authors
  1. Yi Chen
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  2. Lei Guo
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  3. Yongqiang Shi
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  4. Gang Ma
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  5. Wei Xue
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  6. Ling He
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  7. Shuqin Ma
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  8. Xinli Ni
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Contributions

YC, LG and YQC protocol/project development, data collection and management, data analysis, manuscript writing/editing. XLN protocol/project development, data analysis, manuscript writing/editing. GM: data analysis, manuscript writing/editing. WX HL and SQM: data collection.

Corresponding author

Correspondence to Xinli Ni.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was in accordance with the ethical standards of the local Medical Ethics Committee of the General Hospital of Ningxia Medical University, Yinchuan, China (No. 2019-382 on 7 June 2019). The study was conducted in accordance with the Declaration of Helsinki.

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Chen, Y., Guo, L., Shi, Y. et al. Norepinephrine prophylaxis for postspinal anesthesia hypotension in parturient undergoing cesarean section: a randomized, controlled trial. Arch Gynecol Obstet 302, 829–836 (2020). https://doi.org/10.1007/s00404-020-05663-7

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  • DOI: https://doi.org/10.1007/s00404-020-05663-7

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