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Review Article   

Minerva Anestesiologica 2022 Jul 05

DOI: 10.23736/S0375-9393.22.16654-X


language: English

Norepinephrine versus phenylephrine for post-spinal hypotension in parturients undergoing caesarean section: a systematic review and meta-analysis

Kamlesh KUMARI 1, Kriti CHAUDHARY 2, Priyanka SETHI 1, Darshana RATHOD 1, Tanvi MESHRAM 1, Nikhil KOTHARI 1, Ankur SHARMA 1, Pradeep BHATIA 1, Surjit SINGH 1

1 Department of Anaesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur, India; 2 Department of Anaesthesiology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India


INTRODUCTION: Multiple studies have compared varying prophylactic and therapeutic doses of norepinephrine and phenylephrine given as either intermittent bolus or fixed-rate infusion to combat post-spinal hypotension in patients undergoing cesarean section (CS). We conducted a systematic review to figure out the best alternative to treat post-spinal hypotension.
EVIDENCE ACQUISITION: PubMed and Cochrane databases were extensively searched for eligible RCTs. A total of 15 studies were found eligible and analysed for the incidence of maternal bradycardia as the primary outcome and other maternal adverse effects, fetal acidosis and Apgar scores at 1 and 5 min as the secondary outcome. Data was analysed using Review Manager Version 5.3. software.
EVIDENCE SYNTHESIS: There was no significant difference in the efficacy of norepinephrine and phenylephrine for managing post-spinal hypotension [OR = 1.15 (95% CI=0.91-1.45),P=0.24, I2=0%,moderate quality] in parturients undergoing CS. Odds of incidence of maternal bradycardia decrease significantly by 61% with norepinephrine versus phenylephrine [OR = 0.39 (95% CI = 0.31-0.49),P<0.00001, I2=27%,high quality evidence]. Significant higher umbilical artery mean pH values were observed with NE versus PE [MD = 0.0 (95%CI=0.00 to 0.01),P=0.03], although not clinical relevant. However, no significant difference was found in the incidence of other maternal adverse effects and fetal outcomes.
CONCLUSIONS: Comparable efficacy for management of post-spinal hypotension, though, norepinephrine was found to cause less incidence of maternal bradycardia as compared to phenylephrine.

KEY WORDS: Anesthesia; Cesarean section; Hypotension; Norepinephrine; Phenylephrine; Spinal

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