TITLE:
Comparison of the Efficacy of Low-Concentration Norepinephrine and Ephedrine in the Management of Post-Spinal Hypotension for Cesarean Section: A Prospective Analytical Study
AUTHORS:
Amine Raja, Yaseen Ahmad, Youssef Mandour, Othmane Tahiri Joutey, Mohammed Thyifa, Amine Afif, Smail El Youssoufi, Saïd Salmi
KEYWORDS:
Spinal Anesthesia, Hypotension, Cesarean Section, Norepinephrine, Ephedrine, Hemodynamics, Obstetric Anesthesia
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.15 No.12,
December
26,
2025
ABSTRACT: Background: Post-spinal hypotension remains the most formidable complication of spinal anesthesia for cesarean delivery, occurring in 70% - 80% of cases and compromising maternal-fetal safety. While ephedrine has long dominated therapeutic management, growing concerns about fetal acidosis have directed research toward safer alternatives. Norepinephrine emerges as a promising candidate with balanced pharmacological properties. This study compares three approaches: bolus ephedrine, bolus norepinephrine, and prophylactic continuous norepinephrine infusion. Methods: Prospective analytical study including 170 parturients undergoing cesarean delivery under spinal anesthesia at University Hospital Mother and Child Harouchi, Ibn Rochd, Hassan II University (February to June 2025). Computer-generated block randomization with sealed envelope allocation concealment into three balanced groups: Group I (ephedrine 3 - 6 mg bolus, n = 57), Group II (norepinephrine 8 - 16 µg bolus, n = 56), Group III (prophylactic continuous norepinephrine infusion 5 µg/kg, n = 57). Sample size calculated a priori for 80% power to detect a 20% difference in efficacy with α = 0.05. Baseline blood pressure is defined as the mean of three measurements after a 10-minute rest. Hemodynamic evaluation at four operative time points. Primary endpoint: hypotension correction efficacy (restoration of SBP > 80% baseline values within 5 minutes of first vasopressor administration). Secondary endpoints: hemodynamic stability, maternal tolerance, neonatal adaptation. Results: Baseline hemodynamic parameters were equivalent among groups (p > 0.05), confirming successful randomization. Highly significant hemodynamic differences between groups during intervention. Group II: fastest blood pressure recovery (SBP 126.2 mmHg ± 1.3 mmHg at T2 vs 80.5 mmHg ± 3.8 mmHg Group I, p Conclusion: Norepinephrine demonstrates clear superiority over ephedrine in managing post-spinal hypotension. Bolus administration offers the best efficacy-safety ratio with rapid hemodynamic recovery and optimal tolerance. Prophylactic continuous infusion represents a promising therapeutic innovation for preventing severe hypotension, redefining management paradigms in obstetric anesthesia.