Norepinephrine infusion is practical to use to reduce hypotension during caesarean section under spinal anaesthesia, and is non-inferior compared with phenylephrine.

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• Ahmed Hasanin, Sarah Amin, Sherin Refaat, Sara Habib, Marwa Zayed, Yaser Abdelwahab, Mohamed Elsayad, Maha Mostafa, Heba Raafat, Ahmed Elshall, and Shimaa Abd El Fatah.
• Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt. Electronic address: ahmedmohamedhasanin@gmail.com.
• Anaesth Crit Care Pain Med. 2019 Dec 1; 38 (6): 601-607.

BackgroundProphylactic 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.MethodsA 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.ResultsOne 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.ConclusionWhen 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.Copyright © 2019 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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