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


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          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.


          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.


          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.


          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.

          Most cited references36

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          International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

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            Analysis of serial measurements in medical research.

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              Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery.

              During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine.

                Author and article information

                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                24 March 2022
                : 16
                : 789-798
                [1 ]Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai, 200092, People’s Republic of China
                Author notes
                Correspondence: Zhiqiang Liu; Zhendong Xu, Department of Anesthesiology, Shanghai First Maternity and Infant Hospital School of Medicine, Tongji University , No. 2699, West Gaoke Road, Shanghai, People’s Republic of China, Email drliuzhiqiang@163.com; btxzd123@126.com

                These authors contributed equally to this work

                © 2022 Du et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                : 07 January 2022
                : 12 March 2022
                Page count
                Figures: 2, Tables: 6, References: 36, Pages: 10
                Funded by: the Clinical Research Plan of SHDC;
                Funded by: Science and Technology Commission of Shanghai Municipality, open-funder-registry 10.13039/501100003399;
                Funded by: Research Fund of Shanghai Association of Chinese Integrative Medicine;
                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.
                Original Research

                Pharmacology & Pharmaceutical medicine
                caesarean section,hypotension,norepinephrine,phenylephrine,spinal anaesthesia,twins


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