Hemodynamics During Cesarean Delivery Under Spinal Anesthesia With Norepinephrine Versus Ephedrine

NCT ID: NCT07322419

Last Updated: 2026-01-14

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

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-01

Study Completion Date

2026-12-31

Brief Summary

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Echocardiography will be used to measure cardiac output and calculate other important hemodynamic variables in healthy patients with full-term singleton pregnancy during cesarean delivery under conventional spinal anesthesia using 2 different vasopressor drugs: norepinephrine in 1 group versus ephedrine in another group.

Detailed Description

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Conditions

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Cesarean Delivery Spinal Anesthesia for Cesarean Section

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Norepinephrine

Group Type EXPERIMENTAL

Spinal Anesthesia with Bupivacaine and Fentanyl

Intervention Type PROCEDURE

Spinal anesthesia using 2.5 mL of 0.5% hyperbaric bupivacaine (12.5 mg) and 15 mcg of fentanyl at the L4-L5 or L3-L4 interspace

Crystalloid Coload 1000 mL

Intervention Type DRUG

Ringer acetate 1000 mL will be administered over 10 minutes starting immediately after intrathecal injection

Cesarean Delivery

Intervention Type PROCEDURE

Lower segment cesarean section using the Pfannenstiel incision and uterine exteriorization

Transthoracic Echocardiography

Intervention Type RADIATION

Measurement of cardiac output in supine position with left lateral tilt at baseline, at 1 and 10 minutes after intrathecal injection, and immediately after delivery

Intravenous Norepinephrine Bolus

Intervention Type DRUG

Prophylactic IV norepinephrine bolus of 6 mcg will be administered immediately after intrathecal injection, followed by rescue IV norepinephrine boluses of 3, 6, and 9 mcg when systolic blood pressure decreases below 90%, 80%, and 70% of baseline value, respectively

Ephedrine

Group Type ACTIVE_COMPARATOR

Spinal Anesthesia with Bupivacaine and Fentanyl

Intervention Type PROCEDURE

Spinal anesthesia using 2.5 mL of 0.5% hyperbaric bupivacaine (12.5 mg) and 15 mcg of fentanyl at the L4-L5 or L3-L4 interspace

Crystalloid Coload 1000 mL

Intervention Type DRUG

Ringer acetate 1000 mL will be administered over 10 minutes starting immediately after intrathecal injection

Cesarean Delivery

Intervention Type PROCEDURE

Lower segment cesarean section using the Pfannenstiel incision and uterine exteriorization

Transthoracic Echocardiography

Intervention Type RADIATION

Measurement of cardiac output in supine position with left lateral tilt at baseline, at 1 and 10 minutes after intrathecal injection, and immediately after delivery

Intravenous Ephedrine Bolus

Intervention Type DRUG

Prophylactic IV ephedrine bolus of 6 mg will be administered immediately after intrathecal injection, followed by rescue IV ephedrine boluses of 3, 6, and 9 mg when systolic blood pressure decreases below 90%, 80%, and 70% of baseline value, respectively

Interventions

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Spinal Anesthesia with Bupivacaine and Fentanyl

Spinal anesthesia using 2.5 mL of 0.5% hyperbaric bupivacaine (12.5 mg) and 15 mcg of fentanyl at the L4-L5 or L3-L4 interspace

Intervention Type PROCEDURE

Crystalloid Coload 1000 mL

Ringer acetate 1000 mL will be administered over 10 minutes starting immediately after intrathecal injection

Intervention Type DRUG

Cesarean Delivery

Lower segment cesarean section using the Pfannenstiel incision and uterine exteriorization

Intervention Type PROCEDURE

Transthoracic Echocardiography

Measurement of cardiac output in supine position with left lateral tilt at baseline, at 1 and 10 minutes after intrathecal injection, and immediately after delivery

Intervention Type RADIATION

Intravenous Norepinephrine Bolus

Prophylactic IV norepinephrine bolus of 6 mcg will be administered immediately after intrathecal injection, followed by rescue IV norepinephrine boluses of 3, 6, and 9 mcg when systolic blood pressure decreases below 90%, 80%, and 70% of baseline value, respectively

Intervention Type DRUG

Intravenous Ephedrine Bolus

Prophylactic IV ephedrine bolus of 6 mg will be administered immediately after intrathecal injection, followed by rescue IV ephedrine boluses of 3, 6, and 9 mg when systolic blood pressure decreases below 90%, 80%, and 70% of baseline value, respectively

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiologists physical status II.
* Singleton, full term pregnancy.
* Scheduled cesarean delivery under spinal anesthesia.

Exclusion Criteria

* Height \<150 or \>180 cm.
* Weight \<60 or \>110 kg.
* Body mass index (BMI) \<18.5 or ≥35 kg/m².
* Women presenting in labor.
* Any contraindication to spinal anesthesia: increased intracranial pressure, coagulopathy, or local skin infection.
* Chronic or pregnancy-induced hypertension.
* Baseline systolic blood pressure \>140 mm Hg.
* Hemoglobin \<10 g/dl.
* Diabetes mellitus, cardiovascular, cerebrovascular, or renal disease.
* Polyhydramnios or known significant fetal abnormalities.
* Current administration of vasoactive drugs such as: beta blockers, salbutamol, or thyroxin.
Minimum Eligible Age

19 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Mansoura University

OTHER

Sponsor Role lead

Responsible Party

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Mohamed Mohamed Tawfik

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals

Al Mansurah, Dakahlia Governorate, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Mohamed M Tawfik, MD

Role: CONTACT

0020 1001183400

Facility Contacts

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Mohamed M Tawfik, MD

Role: primary

0020 1001183400

Other Identifiers

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MD.25.04.982

Identifier Type: -

Identifier Source: org_study_id

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