Phenylephrine and Noradrenaline for Post Spinal Anesthesia Hypotension

NCT ID: NCT03015857

Last Updated: 2017-05-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2017-04-30

Brief Summary

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Hypotension following spinal anesthesia for cesarean section is a serious problem. In this study we investigated the effect of the vasopressors phenylephrine and noradrenaline on postspinal hypotension.

Detailed Description

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On arrival to the operating room, an 18g cannula will be inserted and monitors will be applied (electrocardiography - pulse oximetry - non-invasive blood pressure monitor). Patients will receive spinal anesthesia with 500 ml rapid crystalloid co-load. Ten milligrams heavy bupivacaine in addition to 20 mcg fentanyl will be injected in L3-L4 or L4-L5 interspace using 25 g spinal needle in the sitting position.

After spinal block, patients will be randomly allocated into one of two groups:

* Phenylephrine group (n=100)
* Norepinephrine group (n=100)

Patients who shows SBP above 140 mmHg or heart rate below 55 bpm after the first vasopressor dose will not receive the infusion. The infusion will stop if the SBP was above 140 mmHg or if the heart rate was below 55 bpm. Patients will be positioned in the supine position with left lateral tilt. Block success will be assessed using pinprick, patients with failed block will be excluded from the study. The highest sensory block level will be assessed after 5 minutes from intrathecal injection. Co-hydration will be continued till maximum of 1.5 litres.

Conditions

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Adverse Anesthesia Outcome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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phenylephrine,

\- Phenylephrine group (n=100): will receive 100 mcg phenylephrine as a single bolus just after intrathecal injection of 10 mg bupivacaine plus 20 mcg fentanyl. The dose will be diluted in 5 mL and given over seconds. A continuous infusion with placebo (normal saline) will start after the first bolus.

Group Type ACTIVE_COMPARATOR

phenylephrine

Intervention Type DRUG

\- phenylephrine; a vasopressor drug given to prevent post spinal hypotension

Bupivacaine

Intervention Type DRUG

intrathecal bupivacaine 10 mg will be given in both groups

Fentanyl

Intervention Type DRUG

intrathecal fentanyl 20 mcg will be given in both groups

Placebo (normal saline)

Intervention Type DRUG

norepinephrine

\- Norepinephrine group (n=100): will receive bolus of norepinephrine (10 mcg) directly after spinal block using 10 mg bupivacaine plus 20 mcg fentantanyl followed by continuous infusion of norepinephrine with a rate of 0.1 mcg/kg/min till delivery of the fetus.

Group Type ACTIVE_COMPARATOR

Norepinephrine

Intervention Type DRUG

\- norepinephrine; a vasopressor drug given to prevent post spinal hypotension

Bupivacaine

Intervention Type DRUG

intrathecal bupivacaine 10 mg will be given in both groups

Fentanyl

Intervention Type DRUG

intrathecal fentanyl 20 mcg will be given in both groups

Interventions

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phenylephrine

\- phenylephrine; a vasopressor drug given to prevent post spinal hypotension

Intervention Type DRUG

Norepinephrine

\- norepinephrine; a vasopressor drug given to prevent post spinal hypotension

Intervention Type DRUG

Bupivacaine

intrathecal bupivacaine 10 mg will be given in both groups

Intervention Type DRUG

Fentanyl

intrathecal fentanyl 20 mcg will be given in both groups

Intervention Type DRUG

Placebo (normal saline)

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* full term singleton parturients
* elective cesarean sections

Exclusion Criteria

* cardiac morbidities
* hypertensive disorders of pregnancy
* peripartum bleeding
* body mass index \> 35 will be excluded from the study
Minimum Eligible Age

18 Years

Maximum Eligible Age

35 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Kasr El Aini Hospital

OTHER

Sponsor Role lead

Responsible Party

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ahmed elsakka

Principal investigator and lecturer of anesthesia, faculty of medicine cairo university

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shereen Refaat, M.D.

Role: STUDY_CHAIR

Lecturer of anesthesia Faculty of medicine Cairo university

Tamer M Rook, M.D.

Role: STUDY_CHAIR

Lecturer of anesthesia Faculty of medicine Cairo university

Other Identifiers

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cesarean sections

Identifier Type: -

Identifier Source: org_study_id

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