Trial reportBMC anesthesiology2022
Norepinephrine versus phenylephrine infusion for preventing postspinal hypotension during cesarean section for twin pregnancy: a double-blinded randomized controlled clinical trial.
Trial report in BMC anesthesiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Pooled it
- Norepinephrine vs. phenylephrine for spinal hypotension in cesarean section: a network meta-analysis.Journal of anesthesia · 2025Pooled it
- 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.Frontiers in pharmacology · 2022Pooled it
- Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section.BMC anesthesiology · 2025Trial
- Serial transthoracic echocardiography for hemodynamic monitoring and early warning of hypotension during elective cesarean delivery: a prospective observational study.Journal of clinical monitoring and computing · 2026Article
- In reply to the comments by Onitsuka et al.Journal of anesthesia · 2026Article
- Anesthetic approaches for malpresentation and multiple gestation.Current opinion in anaesthesiology · 2026Review
- Neonatal outcome following norepinephrine versus phenylephrine for treatment of spinal-induced hypotension among women undergoing caesarean section: systematic review and meta-analysis of randomised controlled trials.Perioperative medicine (London, England) · 2026Review
- Comparison of Two Different Norepinephrine Bolus Doses for Management of Spinal Anesthesia-Induced Maternal Hypotension in Cesarean Section: A Double-Blind Randomized Controlled Study.Journal of clinical medicine · 2025Article
- Dissecting Vasopressor Efficacy in the Management of Maternal Hypotension in Preeclamptic Cesarean Delivery: A Systematic Review of Randomized Controlled Trials.Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2025Article
- Effect of prophylactic phenylephrine versus norepinephrine on foeto-maternal outcomes in caesarean delivery under neuraxial anaesthesia: A systematic review and meta-analysis with trial sequential analysis.Indian journal of anaesthesia · 2025Article
- Heavy gravity combined with light gravity local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in maternal women: a prospective cohort study.BMC anesthesiology · 2025Article
- A Comparison of Norepinephrine versus Phenylephrine to Prevent Hypotension after Spinal Anesthesia for Cesarean Section: Systematic Review and Meta-Analysis.Journal of personalized medicine · 2024Review
- Article
- Article
- Comparison of Prophylactic Infusion of Phenylephrine Versus Norepinephrine for the Prevention of Post Spinal Hypotension in Parturients Undergoing Elective Caesarean Section-a Randomized, Double-Blinded, Non-Inferiority Trial.Turkish journal of anaesthesiology and reanimation · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCompared with singleton pregnancy, twin gestation is featured by a greater increase in cardiac output. Therefore, norepinephrine might be more suitable than phenylephrine for maintaining blood pressure during cesarean section for twins, as phenylephrine causes reflex bradycardia and a resultant decrease in cardiac output. This study was to determine whether norepinephrine was superior to phenylephrine in maintaining maternal hemodynamics during cesarean section for twins.
methodsInformed consent was obtained from all the patients before enrollment. In this double-blinded, randomized clinical trial, 100 parturients with twin gestation undergoing cesarean section with spinal anesthesia were randomized to receive prophylactic norepinephrine (3.2 μg/min) or phenylephrine infusion (40 μg/min). The primary outcome was the change of heart rate and blood pressure during the study period. The secondary outcomes were to compare maternal complications, neonatal outcomes, Apgar scores and umbilical blood acid-base status between the two vasopressors.
resultsThere was no significant difference observed for the change of heart rate between two vasopressors. The mean standardized area under the curve of heart rate was 78 ± 12 with norepinephrine vs. 74 ± 11 beats/min with phenylephrine (mean difference 4.4, 95%CI - 0.1 to 9.0; P = .0567). The mean standardized area under the curve of systolic blood pressure (SBP) was significantly lower in parturients with norepinephrine, as the mean of differences in standardized AUC of SBP was 6 mmHg, with a 95% CI from 2 to 9 mmHg (P = .0013). However, requirements of physician interventions for correcting maternal hemodynamical abnormalities (temporary cessation of vasopressor infusion for reactive hypertension, rescuing vasopressor bolus for hypotension and atropine for heart rate less < 50 beats/min) and neonatal outcomes were also not significantly different between two vasopressors.
conclusionInfusion of norepinephrine was not associated with less overall decrease in heart rate during cesarean section for twins, compared with phenylephrine.
trial registrationChinese Clinical Trial Registry ( ChiCTR1900021281 ).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.