Norepinephrine versus ephedrine for blood pressure control during cesarean with spinal anesthesia.
Official title: Echocardiographic Evaluation of Cardiac Output During Cesarean Delivery Under Spinal Anesthesia Using Norepinephrine Versus Ephedrine: A Randomized Controlled Trial
Run by Mansoura University · NCT07322419 · Data updated 2026-11-12
This test will see if norepinephrine or ephedrine better keeps blood pressure and cardiac output stable during spinal anesthesia for healthy women having a scheduled full‑term cesarean.
Quick facts
| Phase | Phase 4 |
|---|---|
| Study type | Interventional |
| Ages | 19 Years to 40 Years |
| Sex | Women only |
| Enrollment | 200 (estimated) |
| Sponsor | Mansoura University Academic / other |
| Locations | 1 site (Al Mansurah, Dakahlia Governorate) |
| Status | Recruiting |
| Started | January 1, 2026 |
| Main results expected | December 31, 2026 |
| Study ends | December 31, 2026 |
| Registry record updated | January 14, 2026 |
| Trial ID | NCT07322419 on ClinicalTrials.gov |
Is this trial a fit for you?
✓Likely a good fit
Ideal candidates are healthy ASA II women with full‑term singleton pregnancies scheduled for elective cesarean under spinal anesthesia who meet the study's height, weight, and BMI limits and have no hypertension, diabetes, or major medical conditions.
✕Probably not a fit
Women in active labor, with multiple pregnancies, significant comorbidities (cardiac, renal, cerebrovascular disease), preexisting hypertension or diabetes, extreme BMI, anemia, or contraindications to spinal anesthesia are excluded and would not receive benefit from participation.
A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.
What this trial studies
This Phase 4 interventional trial enrolls healthy, ASA II women with full‑term singleton pregnancies scheduled for cesarean delivery under spinal anesthesia. Participants receive standard spinal anesthesia with bupivacaine and fentanyl plus a 1000 mL crystalloid coload and are randomized to receive either intravenous norepinephrine or ephedrine bolus as the vasopressor. Transthoracic echocardiography is used perioperatively to measure cardiac output and derive other hemodynamic variables while blood pressure and vital signs are continuously monitored. Patients with significant comorbidities, abnormal BMI/height/weight ranges, preexisting hypertension, diabetes, anemia, or contraindications to spinal anesthesia are excluded.
Why it matters
Potential benefit: If successful, the results could identify which vasopressor better preserves maternal blood pressure and cardiac output during cesarean, potentially improving maternal stability and fetal safety.
How similar studies have gone: Previous randomized trials comparing vasopressors for cesarean under spinal anesthesia have suggested norepinephrine may better maintain blood pressure with less maternal tachycardia and comparable or improved fetal acid‑base status versus ephedrine, so this approach has supporting evidence but remains actively studied.
Who can join: the full rules
Show full inclusion / exclusion criteria
Inclusion Criteria: * American Society of Anesthesiologists physical status II. * Singleton, full term pregnancy. * Scheduled cesarean delivery under spinal anesthesia. Exclusion Criteria: * Height \<150 or \>180 cm. * Weight \<60 or \>110 kg. * Body mass index (BMI) \<18.5 or ≥35 kg/m². * Women presenting in labor. * Any contraindication to spinal anesthesia: increased intracranial pressure, coagulopathy, or local skin infection. * Chronic or pregnancy-induced hypertension. * Baseline systolic blood pressure \>140 mm Hg. * Hemoglobin \<10 g/dl. * Diabetes mellitus, cardiovascular, cerebrovascular, or renal disease. * Polyhydramnios or known significant fetal abnormalities. * Current administration of vasoactive drugs such as: beta blockers, salbutamol, or thyroxin.
Where it's running
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Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals
Al Mansurah, Dakahlia Governorate, Egypt Recruiting
Study contacts
- Study coordinator: Mohamed M Tawfik, MD
- Email: m2tawfik@mans.edu.eg
- Phone: 0020 1001183400
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How to take part
- Review the eligibility criteria above with your treating physician.
- Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
- Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.