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AnesthesiaPhase 4NORPHE-CDNCT07327320

Norepinephrine vs. Phenylephrine for Hypotension in Low-Dose Spinal Anesthesia for Cesarean Delivery

A Phase 4 study testing Norepinephrine and Phenylephrine in people with Anesthesia and Spinal, run by Tam Anh Research Institute at 1 site in Vietnam.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This clinical trial was conducted to compare the effectiveness and safety of two medications, norepinephrine and phenylephrine, in preventing hypotension during low-dose spinal anesthesia for cesarean delivery (CD). Read more about this study

Who is it for?
Ages 18 years and older, women onlyHealthy volunteers can take part
Conditions the study is for
Anesthesia, Spinal, Cesarean Section
What is being tested?
Norepinephrine and Phenylephrine
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
100 participants
Where
1 siteVietnam
Study dates
6 Jun 2024to 4 Oct 2025
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Parturients aged ≥18 years
  • Classified as American Society of Anesthesiologists physical status II
  • Term singleton pregnancies
  • Scheduled for elective CD under SA

Who cannot join

  • Refusal to participate.
  • Fetal anomalies or suspected fetal compromise
  • Preeclampsia or eclampsia
  • Conversion to general anesthesia or use of labor analgesia
  • Contraindication to SA
  • Preexisting cardiovascular or cerebrovascular disease; chronic hypertension
Show all 10Show fewer
  • Baseline bradycardia
  • Current use of cardiovascular or antihypertensive medications
  • Body mass index more than 40 kg/m²
  • Body weight less than 50 kg or more than 100 kg

Trial locations and contacts

1 site in 1 country.

Vietnam1 site
  • Tam Anh TP. Ho Chi Minh General Hospital

    Ho Chi Minh City, Ho Chi Minh, 700000

Other trials in Vietnam

About this study

Official title: Comparison of Continuous Norepinephrine and Phenylephrine Infusion for Preventing Hypotension During Low-Dose Spinal Anesthesia in Cesarean Delivery: A Randomized Controlled Trial

This clinical trial was conducted to compare the effectiveness and safety of two medications, norepinephrine and phenylephrine, in preventing hypotension during low-dose spinal anesthesia for cesarean delivery (CD). Although low-dose spinal anesthesia combined with opioids is widely used to mitigate hypotension, the incidence remains unacceptably high. Thus, vasopressors remain essential in maintaining maternal blood pressure during these procedures.

In this study, 100 women were initially assessed, with 2 excluded. The remaining 98 were randomly assigned to receive a continuous infusion of either norepinephrine or phenylephrine. During the follow-up process, 2 patients from each group were lost, resulting in 47 participants per group for final analysis.

Read more

The results showed that norepinephrine was significantly more effective, with a lower incidence of hypotension (14.9% vs. 42.6%). It also provided more stable heart rates with fewer episodes of bradycardia and less need for rescue medications. Both treatments were safe for the babies with comparable Apgar scores.

This study suggests that Norepinephrine infusion at 0.05 mcg/kg/min is more effective than phenylephrine at 0.25 mcg/kg/min in preventing hypotension during low-dose SA in CD, providing better hemodynamic stability and fewer episodes of bradycardia

Read the detailed description

Upon arrival in the operating room, the parturient was monitored using standard American Society of Anesthesiologists monitors, including electrocardiography, pulse oximetry, and invasive arterial BP measurement. A large peripheral vein was cannulated using an 18-gauge intravenous catheter for the administration of fluids and medications. Baseline BP was determined by averaging three measurements taken 2 minutes apart in the supine position before SA. Low-dose SA was performed with 8 mg of bupivacaine (Marcain) combined with 20 mcg of fentanyl and 100 mcg of morphine (Opiphine). At injection, patients received 15 ml/kg of 0.9% saline IV and group-specific vasopressors:

  • P group: Continuous intravenous phenylephrine infusion was administered at 0.25 mcg/kg/min, prepared by diluting 500 mcg in 50 mL of 0.9% sodium chloride.
  • N group: Continuous intravenous norepinephrine infusion was administered at 0.05 mcg/kg/min, prepared by diluting 100 mcg in 50 mL of 0.9% sodium chloride.

Following SA, patients were placed in a 15° left lateral tilt and administered 4 mg of ondansetron and 4 mg of dexamethasone intravenously. The sensory block was assessed at 10 minutes; a block at or above the xiphoid was considered effective. After placental delivery, uterotonics were administered as prescribed by the obstetrician. Vasopressor infusion was stopped 5 minutes after delivery.

BP and heart rate (HR) were recorded every 2 minutes during the first 30 minutes after SA, then every 5 minutes until the end of surgery. Neonatal HR was monitored continuously, and Apgar scores were assessed at 1 and 5 minutes by a neonatologist.

Management of Hemodynamic Events and Bradycardia Hypotension was defined as systolic blood pressure (SBP) < 90 mmHg or a drop of more than 20% from baseline. Management involved increasing the vasopressor infusion rate by 20%, followed by administration of phenylephrine 50 mcg intravenously if the HR was ≥ 75 bpm, or ephedrine 6 mg IV if HR was < 75 bpm. The infusion rate was returned to baseline once SBP recovered to the target range (80-120% of baseline).

Severe hypotension (SBP < 60% of baseline) was treated using the same approach but with a higher dose of rescue vasopressors: phenylephrine 100 mcg IV or ephedrine 12 mg IV, depending on HR.

In cases of hypertension (SBP > 120% of baseline), the vasopressor infusion was reduced by 50%. If the SBP exceeded 130%, the infusion was temporarily stopped and reinitiated at 50% of the original dose once the SBP returned to the target range.

Bradycardia was defined as a HR of less than 60 bpm. Management of bradycardia was based on the patient's hemodynamic status. If bradycardia occurred without hypotension, the vasopressor infusion was temporarily discontinued, and if the HR recovered to ≥ 60 bpm, the infusion was resumed at 50% of the original dose. Persistent bradycardia (>3 minutes) was treated with atropine 0.5 mg IV, up to 3 doses. If bradycardia was associated with hypotension, ephedrine 6 mg IV was administered.

Being tested
Norepinephrine, Phenylephrine
Keywords
Norepinephrine, Phenylephrine, Hypotension, Spinal anaesthesia, Cesarean delivery
Medical subject headings
Hypotension

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • NorepinephrineDrug

    Continuous intravenous norepinephrine infusion was administered at 0.05 mcg/kg/min, prepared by diluting 100 mcg in 50 mL of 0.9% sodium chloride

  • PhenylephrineDrug

    Continuous intravenous phenylephrine infusion was administered at 0.25 mcg/kg/min, prepared by diluting 500 mcg in 50 mL of 0.9% sodium chloride

Study groups in NCT07327320
Study groupRoleWhat they receive
NorepinephrineExperimentalContinuous intravenous norepinephrine infusion was administered at 0.05 mcg/kg/min, prepared by diluting 100 mcg in 50 mL of 0.9% sodium chloride
Receives: Drug: Norepinephrine
PhenylephrineExperimentalContinuous intravenous phenylephrine infusion was administered at 0.25 mcg/kg/min, prepared by diluting 500 mcg in 50 mL of 0.9% sodium chloride
Receives: Drug: Phenylephrine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Hypotension

    Hypotension was defined as systolic blood pressure (SBP) < 90 mmHg or a drop of more than 20% from baseline.

    Measured: From the completion of spinal injection until 5 minutes after the neonate is delivered.

Secondary outcomes (6)
  1. Bradycardia

    Bradycardia was defined as a HR of less than 60 beat per minute.

    Measured: From the completion of spinal injection until 5 minutes after the neonate is delivered.

  2. Hypertension

    Hypertension was defined as systolic blood pressure (SBP) > 120% of baseline.

    Measured: From the completion of spinal injection until 5 minutes after the neonate is delivered

  3. Severe hypotension

    Severe hypotension was defined as systolic blood pressure (SBP) < 60% of baseline

    Measured: From the completion of spinal injection until 5 minutes after the neonate is delivered

  4. Requirement for rescue vasopressors (phenylephrine or ephedrine) and atropine

    Requirement for rescue vasopressors (phenylephrine or ephedrine) and atropine during vasopressor administration

    Measured: From the completion of spinal injection until 5 minutes after the neonate is delivered

  5. Nausea and vomiting

    Maternal intraoperative nausea or vomiting during vasopressor administration

    Measured: From the completion of spinal injection until 5 minutes after the neonate is delivered

  6. Neonatal Apgar Score

    The Apgar score is a standardized clinical assessment tool used to evaluate the physical condition of newborns immediately after birth. The title "Apgar" stands for Appearance, Pulse, Grimace, Activity, and Respiration. In this study, the assessment is performed by a qualified neonatologist. Each of the five criteria is scored from 0 to 2, resulting in a total score ranging from 0 to 10.

    Minimum Value: 0. Maximum Value: 10

    Interpretation:

    Scores 0-3: Critically low; indicates the newborn requires immediate life-saving resuscitation.

    Scores 4-6: Fairly low; indicates the newborn may require some resuscitative measures or close monitoring.

    Scores 7-10: Normal; indicates the newborn is in good to excellent condition. Direction: Higher scores represent a better clinical outcome for the neonate.

    Measured: At 1 and 5 minutes after birth

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Jan 2026
  2. Study start6 Jun 2024
  3. Primary completion4 Oct 2025
  4. Study completion4 Oct 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
This was a randomized, controlled, single-blind trial with a parallel group design and a 1:1 allocation ratio.
Masking
Single blind
Who is masked
Participant
Enrolment
100 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07327320
Sponsor's protocol ID
TA2.24.03
Acronym
NORPHE-CD
Status last verified
Dec 2025
First submitted
24 Dec 2025
Last updated
21 Jan 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • 1. Afolabi BB, Lesi FEA. Regional versus general anaesthesia for caesarean section. Cochrane Database of Systematic Reviews. 2012(10). doi: 10.1002/14651858.CD004350.pub3. PubMed PMID: CD004350. 2. Vallejo MC, Attaallah AF, Elzamzamy OM, Cifarelli DT, Phelps AL, Hobbs GR, et al. An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery. International journal of obstetric anesthesia. 2017;29:18-25. Epub 2016/10/11. doi: 10.1016/j.ijoa.2016.08.005. PubMed PMID: 27720613. 3. Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta anaesthesiologica Scandinavica. 2010;54(8):909-21. Epub 2010/05/12. doi: 10.1111/j.1399-6576.2010.02239.x. PubMed PMID: 20455872. 4. Herbosa GAB, Tho NN, Gapay AA, Lorsomradee S, Thang CQ. Consensus on the Southeast Asian management of hypotension using vasopressors and adjunct modalities during cesarean section under spinal anesthesia. Journal of Anesthesia, Analgesia and Critical Care. 2022;2(1):56. doi: 10.1186/s44158-022-00084-1. 5. Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73(1):71-92. Epub 2017/11/02. doi: 10.1111/anae.14080. PubMed PMID: 29090733. 6. Allen TK, George RB, White WD, Muir HA, Habib AS. A double-blind, placebo-controlled trial of four fixed rate infusion regimens of phenylephrine for hemodynamic support during spinal anesthesia for cesarean delivery. Anesthesia and analgesia. 2010;111(5):1221-9. Epub 2010/05/25. doi: 10.1213/ANE.0b013e3181e1db21. PubMed PMID: 20495139. 7. Habib AS. A Review of the Impact of Phenylephrine Administration on Maternal Hemodynamics and Maternal and Neonatal Outc

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Norepinephrine and Phenylephrine in people with Anesthesia and Spinal, run by Tam Anh Research Institute at 1 site in Vietnam.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Vietnam. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hypotension (time frame: From the completion of spinal injection until 5 minutes after the neonate is delivered.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07327320, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Jan 2026.

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