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

Comparative efficacy and safety of prophylactic norepinephrine and phenylephrine in spinal anesthesia for cesarean section: A systematic review and meta-analysis with trial sequential analysis

“…Reactive hypertension may occur after prophylactic use of vasopressors, and in this analysis, eight studies ( Hasanin et al, 2019 ; Sharkey et al, 2019 ; Theodoraki et al, 2020 ; Chen et al, 2022 ; Du et al, 2022 ; Guo et al, 2022 ; Singh et al, 2022 ; Zhou et al, 2022 ) documented the occurrence of hypertension in both groups, with no significant heterogeneity between the included reports ( p = 0.62, I 2 = 0%). Analysis using a fixed effects model showed that the incidence of hypertension was significantly lower in the norepinephrine group than in the control category (RR = 0.58, 95% CI 0.40 to 0.83, p = 0.003), as shown in Figure 5 .…”

“…A total of 12 studies ( Dong et al, 2017 ; Vallejo et al, 2017 ; Hasanin et al, 2019 ; Sharkey et al, 2019 ; Theodoraki et al, 2020 ; Berawala et al, 2021 ; Eskandr et al, 2021 ; Chen et al, 2022 ; Du et al, 2022 ; Guo et al, 2022 ; Singh et al, 2022 ; Zhou et al, 2022 ) were included, all of which were published in the last 5 years. Five ( Dong et al, 2017 ; Chen et al, 2022 ; Du et al, 2022 ; Guo et al, 2022 ; Zhou et al, 2022 ) of the studies were conducted in China, two ( Berawala et al, 2021 ; Singh et al, 2022 ) in India, two ( Hasanin et al, 2019 ; Eskandr et al, 2021 ) in Egypt, and the remaining three ( Vallejo et al, 2017 ; Sharkey et al, 2019 ; Theodoraki et al, 2020 ) in Canada, the United States, and Greece, respectively, with participants ranging from 18 to 45 years. One of the studies involved an intervention in which a dose of the study drug was administered intravenously, immediately after spinal anesthesia, while the remaining administered the study drug at a fixed rate.…”

“…Pooled analysis of all the included studies showed that the incidence of bradycardia was recorded in all the 12 articles (Dong et al, 2017;Vallejo et al, 2017;Hasanin et al, 2019;Sharkey et al, 2019;Theodoraki et al, 2020;Berawala et al, 2021;Eskandr et al, 2021;Chen et al, 2022;Du et al, 2022;Guo et al, 2022;Singh et al, 2022;, with no significant heterogeneity between studies (p = 0.44, I 2 = 0%). Meta-analysis using a fixed effects model showed that the incidence of bradycardia was significantly lower and statistically different in the prophylactic norepinephrine group compared to the phenylephrine category (RR = 0.37, 95% CI: 0.28 to 0.49, p < 0.00001), Figure 3 A. Bradycardia was defined as having less than 50 beats/min in three studies (Sharkey et al, 2019;Eskandr et al, 2021;, which were excluded from the analyses.…”

“…A total of 12 studies (Dong et al, 2017;Vallejo et al, 2017;Hasanin et al, 2019;Sharkey et al, 2019;Theodoraki et al, 2020;Berawala et al, 2021;Eskandr et al, 2021;Chen et al, 2022;Du et al, 2022;Guo et al, 2022;Singh et al, 2022; were included, all of which were published in the last 5 years. Five (Dong et al, 2017;Chen et al, 2022;Du et al, 2022;Guo et al, 2022; of the studies were conducted in China, two (Berawala et al, 2021;Singh et al, 2022) in India, two (Hasanin et al, 2019;Eskandr et al, 2021) in Egypt, and the remaining three (Vallejo et al, 2017;Sharkey et al, 2019;Theodoraki et al, 2020) in Canada, the United States, and Greece, respectively, with participants ranging from 18 to 45 years. One of the studies involved an intervention in which a dose of the study drug was administered intravenously, immediately after spinal anesthesia, while the remaining administered the study drug at a fixed rate.…”

“…Sensitivity analysis was then conducted by excluding the studies one by one, and there was still great heterogeneity among the reports. The source of heterogeneity was further investigated and it was discovered that some studies reported the pH values as medians (quartiles) (Dong et al, 2017;Vallejo et al, 2017; Frontiers in Pharmacology frontiersin.org Hasanin et al, 2019;Theodoraki et al, 2020;Du et al, 2022) yet the present analysis used a Box-Cox (BC) formula for estimating the mean ± standard deviation, followed by metaanalysis. This difference in the estimation method was thought to be possible source of heterogeneity.…”