- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03706755
Comparison of Two Doses of Norepinephrine in Preventing Hypotension After Spinal Anesthesia
Comparison of Two Doses of Norepinephrine in Preventing Hypotension After Spinal Anesthesia for Cesarean Section
Study Overview
Status
Intervention / Treatment
Detailed Description
This study will be a prospective, randomized, active treatment controlled trial.
After written and informed consent, the study participants will be randomly assigned using a computer generated table to 1 of 2 treatment groups prior to cesarean delivery.
Group A will receive an intravenous bolus of 1mcg/Kg of norepinephrine bitartrate to maintain systolic blood pressure (SBP) within 80-120% of baseline before the spinal anesthesia.
Group B will receive an intravenous bolus of 0.5mcg/kg of norepinephrine bitartrate to maintain systolic blood pressure (SBP) within 80-120% of baseline before the spinal anesthesia.
Patients will be admitted to holding area. Baseline arterial blood pressure and heart rate will be measured in supine position, with left uterine displacement. Baseline blood pressure will be calculated as the mean of three consecutive SBP measurements taken 3 minutes apart. 500 mL of Lactated Ringers solution will be administered immediately after induction of spinal anesthesia at the outflow rate of 100ml per hour.
The primary endpoints are:
the timing of the first maternal hypotension before delivery (defined as a decrease of SBP >20% of baseline and/or PAS<100mmHg) the delta PAS and delta PAM before delivery ( difference between basline and the lowest systolic and mean blood pressure respectively)
The secondary endpoints are:
Incidence of hypotension,norepinephrine consumption (mean dose of Norepinephrine to maintain blood pressure between 80 and 100 % of baseline values after the primary preventive bolus), nausea and vomiting will be recorded whenever present during the surgical procedure as well as reactive hypertension (defined as a rise of SBP >20% of baseline or SBP>140mmHg) and arrhythmia. Bradycardia (HR less than 50 BPM) will be treated with Atropine 0.5mg IV. Fetal cord blood analysis will be done immediately after delivery in order to determine the pH value ( ie : logarithm of the blood concentration of hydrogen ions H+)in each group
Study participants will receive a standard spinal anesthetic consisting of 0.5% hyperbaric bupivacaine (2 mL) with either sufentanil (5 mcg) or fentanyl (50 mcg) at L3-4 or L4-5. Prior to surgical incision, the spinal sensory level will be tested to the bilateral T6-T4 dermatomal level. The patients will be positioned supine with a wedge placed under the right hip to avoid aortocaval compression. Both the patient and the researcher's assistant (who will collect data) will be blinded as to the administered Norepinephrine bolus A or B.
When PAS<80% of baseline or < 100 mmHg a bolus of Norepinephrine will be administrated(half dose A or B).
The study will end when cesarean section is completed and the patient transferred to the post-operative care unit.
Measured variables will include systolic, diastolic and mean non-invasive blood pressure, heart rate, number of rescue boluses , incidence of nausea and vomiting (NV), incidence of arrhythmia, Apgar score and fetal cord blood analysis (pH) at delivery.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
-
Tunis, Tunisia, 1007
- Tunis maternity and neonatology center, minisetry of public health
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Elective or semi-urgent CD under spinal anesthesia
- Age over 18 years
- Healthy singleton pregnancy beyond 36 weeks' gestation
- American Society of Anesthesiologists (ASA) physical status classification 2
- Weight 50 to 100 kg, and height 150 to 180 cm
Exclusion Criteria:
- Emergency CD red code
- Allergy or hypersensitivity to norepinephrine or sulfite
- Preexisting or pregnancy-induced hypertension, preeclampsia, eclampsia, the use of cardiac medication or medication for blood pressure control
- multiple gestation
- Cardiovascular or cerebrovascular disease
- Fetal abnormalities
- Suspicion of abnormal placentation
- History of diabetes mellitus (excluding gestational diabetes)
- Use of monoamine oxidase inhibitors, triptyline or imipramine antidepressants
- documented history of postoperative nausea and vomiting, previous gastric bypass surgery, history of chronic opioid use (chronic pain syndrome)
- Patient refusal
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: A
group A: will receive 1 mcg/Kg of Norepinephrine intravenously
|
intervention:Parturients will receive Norepinephrine: a bolus of 1 mcg/Kg immediately after SA (preventive bolus) then they will receive complementary doses of Norepinephrine (half dose: 0.5 mcg/Kg) to maintain systolic blood pressure above 80 % of baseline
Other Names:
|
Active Comparator: B
group B: will receive 0.5 mcg/Kg of Norepinephrine intravenously
|
intervention: Parturients will receive Norepinephrine: a bolus of 0.5 mcg/Kg immediately after SA (preventive bolus) then they will receive complementary doses of Norepinephrine (half dose: 0.25 mcg/Kg) to maintain systolic blood pressure above 80 % of baseline
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to administartion of the first rescue bolus
Time Frame: time from immediately after spinal anesthesia until delivery
|
timing of the first hypotension(defined as a decrease of SBP >20% of baseline and/or PAS<100mmHg) recsue bolus will be given at that moment
|
time from immediately after spinal anesthesia until delivery
|
systolic blood pressure variation
Time Frame: time from immediately after spinal anesthesia until delivery
|
difference between the baseline systolic blood pressure (PAS0) and the lowest systolic blood pressure (PASmin) registred before delivery and computed as (PAS min -PAS0)/PAS0
|
time from immediately after spinal anesthesia until delivery
|
mean blood pressure variation
Time Frame: time from immediately after spinal anesthesia until delivery
|
difference between the baseline mean blood pressure(PAM0) and the lowest mean blood pressure (PAMmin) registred before delivery and computed as (PAM min -PAM0)/PAM0
|
time from immediately after spinal anesthesia until delivery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of hypotension
Time Frame: tile from right after spinal anesthesia until delivery
|
incidence of hypotension after the primary preventive bolus
|
tile from right after spinal anesthesia until delivery
|
Norepinephrine consumption
Time Frame: time fro right after spinal anesthesia until the end of surgery
|
Mean dose of Norepinephrine ( micrograms) given to maintain blood pressure between 80 and 100 % of baseline values after the primary preventive bolus
|
time fro right after spinal anesthesia until the end of surgery
|
Nausea
Time Frame: time of surgery (right after spinal anesthesia until end of surgery)
|
Incidence of nausea.
Measure will be done according to a simple scale: 0= no nausea; 1= nausea [Time
|
time of surgery (right after spinal anesthesia until end of surgery)
|
Vomiting
Time Frame: time of surgery (right after spinal anesthesia until end of surgery)
|
incidence of Vomiting (V) during cesarean section with an infusion of a bolus Norepinephrine.
Measure will be done according to a simple scale: 0= no vomiting; 1= vomiting
|
time of surgery (right after spinal anesthesia until end of surgery)
|
arrhythmia
Time Frame: time of surgery (right after spinal anesthesia until end of surgery)
|
incidence of arrhythmic events during cesarean section with an infusion of a bolus of Norepinephrine
|
time of surgery (right after spinal anesthesia until end of surgery)
|
Hypertension
Time Frame: right after spinal anesthesia until end of surgery)]
|
a rise of systolic blood pressure (SBP)>20% of baseline or SBP>140mmHg
|
right after spinal anesthesia until end of surgery)]
|
mean pH of the fetal cord blood
Time Frame: time of birth
|
Fetal cord blood analysis will be done immediately after delivery in order to determine the pH value ( ie : logarithm of the blood concentration of hydrogen ions H+)in each group
|
time of birth
|
Apgar score
Time Frame: at time of birth
|
apgar at 1 and 5 minutes Apgar at 1 and 5 minutes
|
at time of birth
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: HAYEN Hayen maghrebi, professor, University Tunis El Manar
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Hypotension
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Sympathomimetics
- Vasoconstrictor Agents
- Norepinephrine
Other Study ID Numbers
- Norepinephrine
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Cesarean Section Complications
-
Assiut UniversityNot yet recruitingCesarean Section Complications | Cesarean Section Niche
-
Recep Tayyip Erdogan University Training and Research...CompletedCesarean Section Complications | Cesarean Section; DehiscenceTurkey
-
Ataturk UniversityUnknownCesarean Section Complications | Cesarean Section; Complications, Wound, Dehiscence | Cesarean Section, Repeated | Cesarean, Uterine Scar Thickness | Cesarean, Residual Myometrial ThicknessTurkey
-
Kanuni Sultan Suleyman Training and Research HospitalCompletedCesarean Section Complications | Cesarean Section; DehiscenceTurkey
-
University of CalgaryNot yet recruitingCesarean Section ComplicationsCanada
-
Peking University People's HospitalNot yet recruiting
-
Aswan University HospitalCompletedCesarean Section ComplicationsEgypt
-
Gaziosmanpasa Research and Education HospitalUnknownCesarean Section ComplicationsTurkey
-
Ain Shams UniversityUnknownCesarean Section ComplicationsEgypt
-
Mohamed Abdelrady MohamedCompletedCesarean Section ComplicationsEgypt
Clinical Trials on Norepinephrine: 1mcg/kg
-
General Hospital of Ningxia Medical UniversityCompleted
-
Cairo UniversityCompleted
-
Children's Hospital Medical Center, CincinnatiCompletedHeart DiseaseUnited States
-
Cairo UniversityCompleted
-
University Hospitals Cleveland Medical CenterSuspendedHypospadias | Phimosis | Chordee | Penile TorsionUnited States
-
Peking Union Medical College HospitalRecruiting
-
Atridia Pty Ltd.Linear Clinical ResearchCompleted
-
Green Cross CorporationCompletedMucopolysaccharidosis IIKorea, Republic of
-
Genor Biopharma Co., Ltd.Unknown
-
Kasr El Aini HospitalCompletedCesarean Delivery | Norepinephrine | Postspinal HypotensionEgypt