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Comparison of Norepinehrine Versus Phenylepherine Infusion for Prevention of Post-spinal Hypotension

2026年6月22日 更新者：Ahmed Abdelhameed Fares、Sohag University

Comparison of Norepinephrine Versus Phenylephrine Infusion for Prevention of Hypotension Due to Subarachnoid Block in Elderly Patients Undergoing Orthopedic Hip Surgery:A Prospective Randomized Trial

This prospective randomized double-blinded clinical trial aims to compare the efficacy and hemodynamic effects of prophylactic norepinephrine infusion versus phenylephrine infusion for prevention of spinal anesthesia-induced hypotension in elderly patients undergoing elective orthopedic hip surgery under subarachnoid block. Sixty-two patients aged 60 years or older will be randomly assigned into two equal groups to receive either norepinephrine infusion (8 µg/min) or phenylephrine infusion (100 µg/min) immediately after spinal anesthesia. The primary outcome is the mean heart rate during vasopressor infusion, while secondary outcomes include incidence of hypotension, severe hypotension, bradycardia, reactive hypertension, intraoperative fluid requirements, blood loss, transfusion requirements, and postoperative nausea and vomiting. Hemodynamic parameters will be monitored throughout surgery to evaluate the safety and effectiveness of both vasopressor strategies.

研究概览

地位

招聘中

条件

干预/治疗

详细说明

Spinal anesthesia-induced hypotension is a common and clinically significant complication in elderly patients undergoing orthopedic hip surgery. Age-related physiological changes, impaired autonomic responses, and reduced cardiovascular reserve increase susceptibility to hypotension after subarachnoid block, which may result in organ hypoperfusion, myocardial ischemia, nausea, vomiting, and increased perioperative morbidity.

Phenylephrine is traditionally used for prevention and treatment of spinal anesthesia-induced hypotension because of its potent alpha-adrenergic vasoconstrictive effect. However, its use may be associated with reflex bradycardia and reduction in cardiac output. Norepinephrine, which possesses both alpha-adrenergic and mild beta-adrenergic activity, may provide better maintenance of heart rate and cardiac output while effectively preserving blood pressure.

This prospective randomized double-blinded clinical trial will be conducted at the Department of Anesthesia, Intensive Care and Pain Management, Sohag University Hospitals, after approval from the Institutional Ethics Committee. Elderly patients aged 60 years or older, classified as ASA physical status I-III and scheduled for elective orthopedic hip surgery under spinal anesthesia, will be enrolled after obtaining written informed consent.

研究类型

介入性

注册 (估计的)

62

阶段

  • 第四阶段

联系人和位置

本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。

学习联系方式

研究联系人备份

  • 姓名：Fawzy Abbas Badawy, Professor

学习地点

  • 埃及
      • Sohag、埃及
        • 招聘中
        • Sohag university hospital
        • 接触：
          • Mohamed N Hamdoun, Professor

参与标准

研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

  • 成人
  • 年长者

接受健康志愿者

是的

描述

Inclusion Criteria:

  1. Age 60 years or older.
  2. ASA physical status I-III.
  3. Scheduled for elective hip surgery under subarachnoid block.
  4. Willing to provide written informed consent.

Exclusion Criteria:

  1. Patient refusal.
  2. Contraindications to subarachnoid block.
  3. Severe cardiac disease.
  4. Uncontrolled hypertension.
  5. Allergy to study drugs.
  6. Emergency surgery.
  7. Monoamine oxidase inhibitor use.
  8. Cognitive impairment preventing informed consent.

学习计划

本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。

研究是如何设计的？

设计细节

  • 主要用途：预防
  • 分配：随机化
  • 介入模型：并行分配
  • 屏蔽：双倍的

武器和干预

参与者组/臂
干预/治疗
实验性的：Norepinehrine group
• NE group: norepinephrine infusion at 8 µg/min. Infusion will continue for 45 minutes after spinal anesthesia.
药品：Norepinephrine
norepinephrine infusion at 8 µg/min. Infusion will continue for 45 minutes after spinal anesthesia.
实验性的：Phenylepherine group
PhE group: phenylephrine infusion at 100 µg/min Infusion will continue for 45 minutes after spinal anesthesia.
药品：Phenylephrine
phenylephrine infusion at 100 µg/min. Infusion will continue for 45 minutes after spinal anesthesia.

研究衡量的是什么？

主要结果指标

结果测量
措施说明
大体时间
Mean intaroperative heart rate (beats /minute) during vasopressor infusion measured by continous electrocardiogrammonitoring
大体时间：From the start of subarachnoid block until the end of surgery .
Heart rate will be continously monitored using standar electrocardiogram monitoring. to compare the effect of norepinephrine versus phenylephrine infusion on hemodynamics.
From the start of subarachnoid block until the end of surgery .

次要结果测量

结果测量
措施说明
大体时间
Incidence of spinal anesthesia-induced hypotension
大体时间：From the administration of spinal anesthesia until the end of the procedure.
Defined as a decrease in mean arterial pressure (MAP) to <80% of baseline measurd by non-invasive blood pressure monitoring .
From the administration of spinal anesthesia until the end of the procedure.
Incidence of bradycardia
大体时间：Throughout the intraoperative period
Defined as heart rate ≤ 50 beats/min.
Throughout the intraoperative period
Mean arterial pressure (MAP) trends measured using non-invasive blood pressure monitoring
大体时间：Every 5 minutes from the start of spinal anesthesia until the end of surgery.
Monitoring the stability of blood pressure during vasopressor infusion
Every 5 minutes from the start of spinal anesthesia until the end of surgery.
Incidence of reactive hypertension measured by non-invasive blood pressure monitoring
大体时间：From the start of vasopressor infusion until the end of surgery.
Defined as mean arterial pressure (MAP) > 125% of baseline.
From the start of vasopressor infusion until the end of surgery.
Total intraoperative intavenous fluid
大体时间：At the end of the surgical procedure.
Total volume of intravenous fluids administered in milliliters
At the end of the surgical procedure.

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

赞助

Sohag University

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (实际的)

2026年5月22日

初级完成 (估计的)

2027年3月14日

研究完成 (估计的)

2027年3月14日

研究注册日期

首次提交

2026年5月22日

首先提交符合 QC 标准的

2026年6月22日

首次发布 (实际的)

2026年6月23日

研究记录更新

最后更新发布 (实际的)

2026年6月23日

上次提交的符合 QC 标准的更新

2026年6月22日

最后验证

2026年6月1日

更多信息

与本研究相关的术语

关键字

其他相关的 MeSH 术语

其他研究编号

  • Soh-Med-26-5-9MS

药物和器械信息、研究文件

研究美国 FDA 监管的药品

不

研究美国 FDA 监管的设备产品

不

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