Bandyopadhyay Anjishnujit, Sawhney Chhavi, Haldar Partha, Pathak Sharmishtha
Anaesthesiology, Pain Medicine and Critical Care, JPNATC, AIIMS, Delhi, India.
Community Medicine, AIIMS, Delhi, India.
Indian J Anaesth. 2025 Jul;69(7):638-649. doi: 10.4103/ija.ija_1063_24. Epub 2025 Jun 12.
The prevention of hypotension in parturients scheduled for caesarean section is of utmost importance for improving foeto-maternal outcomes. We compared the prophylactic use of phenylephrine (PE) and norepinephrine (NE) on foeto-maternal outcomes in women undergoing caesarean delivery under neuraxial anaesthesia. Umbilical artery (UA) pH was the primary objective, and umbilical vein (UV) pH, APGAR scores, incidence of bradycardia, hypotension, and hypertension were secondary objectives.
PubMed, EMBASE, Web of Science, Google Scholar, and CENTRAL databases were searched to identify all relevant randomised controlled trials (RCTs) published up to April 2023, further updated till May 2025. Our review was prospectively registered with PROSPERO (ID: CRD42023429328). The effect of PE and NE on UA pH was our primary outcome. The quality of evidence of outcomes was graded using the GRADE methodology. Only RCTs involving term pregnant females undergoing caesarean section under neuraxial anaesthesia were included.
Seventeen trials (2138 patients) were included in the final analysis. NE and PE were comparable in terms of UA and UV pH, with standardised mean difference (SMD) of 0.18 [95% confidence interval (CI): -0.09; 0.45] (I = 81%, < 0.01) and -0.39 (95% CI: -0.82; 0.04) (I = 91%, < 0.01), respectively. NE group had significantly lesser episodes of bradycardia [Relative Risk (RR): 0.44 (95% CI: 0.34; 0.56) (I = 28%, = 0.15)] and hypertension [RR: 0.54 (95% CI: 0.33; 0.90) (I = 0%, = 0.62)], but incidence of hypotension was comparable between groups [RR: 0.99 (95% CI: 0.82; 1.18) (I = 18%, = 0.25)]. Trial sequential analysis revealed that the required information size was reached for the outcome of bradycardia only.
There is insufficient evidence to recommend using NE preemptively to improve foetal outcomes. Further studies are recommended to validate its effect.
预防剖宫产产妇的低血压对于改善母婴结局至关重要。我们比较了去氧肾上腺素（PE）和去甲肾上腺素（NE）在接受椎管内麻醉的剖宫产妇女中预防性使用对母婴结局的影响。脐动脉（UA）pH值是主要观察指标，脐静脉（UV）pH值、阿氏评分、心动过缓、低血压和高血压的发生率是次要观察指标。
检索了PubMed、EMBASE、Web of Science、谷歌学术和CENTRAL数据库，以识别截至2023年4月发表的所有相关随机对照试验（RCT），并进一步更新至2025年5月。我们的综述已在PROSPERO（注册号：CRD42023429328）上进行了前瞻性注册。PE和NE对UA pH值的影响是我们的主要结局。使用GRADE方法对结局的证据质量进行分级。仅纳入了涉及在椎管内麻醉下接受剖宫产的足月妊娠女性的RCT。
最终分析纳入了17项试验（2138例患者）。NE和PE在UA和UV pH值方面相当，标准化均数差（SMD）分别为0.18 [95%置信区间（CI）：-0.09；0.45]（I² = 81%，P < 0.01）和-0.39（95% CI：-0.82；0.04）（I² = 91%，P < 0.01）。NE组的心动过缓发作次数[相对危险度（RR）：0.44（95% CI：0.34；0.56）（I² = 28%，P = 0.15）]和高血压发作次数[RR：0.54（95% CI：0.33；0.90）（I² = 0%，P = 0.62）]显著较少，但两组间低血压的发生率相当[RR：0.99（95% CI：0.82；1.18）（I² = 18%，P = 0.25）]。试验序贯分析显示，仅心动过缓结局达到了所需的信息规模。
没有足够的证据推荐预防性使用NE来改善胎儿结局。建议进一步研究以验证其效果。
