Comparison of Prophylactic Norepinephrine and Phenylephrine Infusions During Spinal Anaesthesia for Primary Caesarean Delivery in Twin Pregnancies: A Randomized Double-Blinded Clinical Study

Drug Des Devel Ther. 2022 Mar 24:16:789-798. doi: 10.2147/DDDT.S357507. eCollection 2022.

Abstract

Background: Norepinephrine has been associated with improved heart rate (HR) and cardiac output (CO) compared to phenylephrine as a treatment for post-spinal hypotension during caesarean delivery (CD) in singleton pregnancies. Our current study compared the effects of norepinephrine and phenylephrine in maintaining maternal hemodynamics after spinal anaesthesia in twin pregnancies during elective CD.

Methods: This was a double-blinded, randomized, controlled study. From December 2017 to December 2018, 62 women with healthy twin term pregnancies undergoing elective CD under spinal anaesthesia were studied. Following spinal induction, either norepinephrine (6 μg/mL) or phenylepinephrine (75 μg/mL) was infused at 60 mL/h to maintain systolic blood pressure (SBP) near baseline until delivery. HR, SBP, systemic vascular resistance (SVR), and CO were collected using anaesthesia monitors and continuous-pulse waveform analysis. The primary outcome was maternal CO. Other parameters of maternal hemodynamics, umbilical cord blood gases, and adverse events were also compared.

Results: Hemodynamic variables (CO, SBP, HR, and SVR) between spinal anaesthesia induction to skin incision were similar between the two groups (P = 0.889, 0.057, 0.977, and 0.416, respectively). The incidence of bradycardia was significantly higher in the phenylephrine group (69%) than in the norepinephrine group (24.2%, P<0.001). Maternal nausea and vomiting, hypotension, reactive hypertension, and neonatal outcomes did not differ between the groups.

Conclusion: When administered as a prophylactic fixed-rate infusion, phenylephrine and norepinephrine are both capable of maintaining maternal blood pressure following spinal anaesthesia in twin pregnancies. There were no differences in the maternal hemodynamics or foetal outcomes between women receiving norepinephrine and phenylephrine.

Previous presentations: Presented at the 51st Society for Obstetric Anesthesia and Perinatology Annual Meeting, Phoenix, Arizona, May 1-5, 2019.

Clinical trial number and registry: No. ChiCTR-IOR-17013358.

Keywords: caesarean section; hypotension; norepinephrine; phenylephrine; spinal anaesthesia; twins.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anesthesia, Spinal* / adverse effects
  • Cesarean Section / adverse effects
  • Female
  • Humans
  • Infant, Newborn
  • Norepinephrine
  • Phenylephrine / pharmacology
  • Pregnancy
  • Pregnancy, Twin
  • Vasoconstrictor Agents / pharmacology

Substances

  • Vasoconstrictor Agents
  • Phenylephrine
  • Norepinephrine

Grants and funding

This work was supported in part by the Clinical Research Plan of SHDC (SHDC22020205), Science and Technology Commission of Shanghai Municipality (19401930500) and Research Fund of Shanghai Association of Chinese Integrative Medicine.