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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02854787
Other study ID # UniversityTunis el manar
Secondary ID
Status Completed
Phase Phase 4
First received July 30, 2016
Last updated October 25, 2017
Start date May 2016
Est. completion date December 2016

Study information

Verified date July 2016
Source University Tunis El Manar
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The purpose of the study is to determine if an intravenous bolus of phenylephrine is more effective compared to an intravenous bolus of norepinephrine associated with crystalloid loading for maintaining blood pressure during a spinal anesthetic for a cesarean delivery. Prevention of low blood pressure has been shown to decrease nausea and vomiting during and after cesarean delivery under spinal anesthesia. For elective cesarean delivery, all participants will receive spinal anesthesia with a local anesthetic and sufentanil. This study plans to enroll 120 pregnant women. Patients will be randomly assigned according to a computer generated system to be in one of two groups.


Description:

This study will be a prospective, randomized, active treatment controlled trial.

After written and informed consent are obtained, the study participants are randomly assigned using a computer generated table to 1 of 2 treatment groups prior to cesarean delivery.

Group A will consist of: An intravenous bolus of 0,2 mcg/Kg of norepinephrine to maintain systolic blood pressure (SBP) within 80-120% of baseline before the spinal.

Group B will consist of: An intravenous bolus of 100mcg of phenylephrine to maintain systolic blood pressure (SBP) within 80-120% of baseline before the spinal.

Patients will be admitted to holding area. Baseline arterial blood pressure and heart rate will be measured in supine position, with left uterine displacement. Baseline blood pressure will be calculated by taking the mean of three consecutive SBP measurements taken 5 minutes apart. 500 mL of Lactated Ringers solution will be administered immediately after induction of spinal anesthesia at the outflow rate of 100ml per hour.

The primary endpoint is the number of provider interventions needed to maintain the SBP within 100-120% of baseline for both groups. The secondary endpoint is nausea measured with each provider intervention after induction of spinal anesthesia, and immediately following delivery with 11 point verbal rating scale (0 = no nausea, 1 = nausea). Vomiting will be recorded whenever present during the surgical procedure.

Bradycardia (HR less than 50 BPM) will be treated with Atropine 0.4mg IV or ephedrine 3 mg - 12 mg IV bolus.

Study participants will receive a standard spinal anesthetic consisting of 0.5% hyperbaric bupivacaine (2 mL) plus sufentanil (5 mcg) at L3-4 or L4-5. Prior to surgical incision, the spinal sensory level will be tested to the bilateral T6-T4 dermatomal level. The patients will be positioned supine with a wedge placed under the right hip to avoid aortocaval compression. Both the patient and the researcher's assistant (who will collect data) will be blinded as to the administered Phenylephrine or norepinephrine bolus. The study will end when cesarean section is completed and the patient transferred to the post-operative care unit.

Measured variables will include systolic, diastolic and mean non-invasive blood pressure, the number and type of interventions for control of blood pressure, heart rate, incidence of nausea and vomiting (NV), incidence of arrhythmia and fetal cord blood analysis (pH) at delivery.


Recruitment information / eligibility

Status Completed
Enrollment 120
Est. completion date December 2016
Est. primary completion date September 2016
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 18 Years to 45 Years
Eligibility Inclusion Criteria:

- of Anesthesiologists (ASA) Physical Status classification 1 and 2

- Pregnant women with singleton pregnancy

Exclusion Criteria:

Study Design


Intervention

Drug:
Phenylephrine
A bolus of 100 mcg
Norepinephrine
A bolus of 0,2 mcg/kg

Locations

Country Name City State
Tunisia Tunis maternity and neonatology center, minisetry of public health Tunis

Sponsors (1)

Lead Sponsor Collaborator
University Tunis El Manar

Country where clinical trial is conducted

Tunisia, 

Outcome

Type Measure Description Time frame Safety issue
Primary Maternal Blood Pressure Measurement of systolic, diastolic and mean, non-invasive blood pressure during cesarean section with an infusion of either Ephedrine or Norepinephrine At time of surgery (right after spinal anesthesia until end of surgery)
Secondary Hemodynamic Parameters - heart rate mean heart rate during cesarean section with an infusion of either Ephedrine or Norepinephrine At time of surgery (right after spinal anesthesia until end of surgery
Secondary Hemodynamic Parameters - arrhythmia incidence of arrhythmic events during cesarean section with an infusion of either Ephedrine or Norepinephrine At time of surgery (right after spinal anesthesia until end of surgery)
Secondary Vomiting incidence of Vomiting (V) during cesarean section with an infusion of either Ephedrine or Norepinephrine. Measure will be done according to a simple scale: 0= no vomiting; 1= vomiting At time of surgery (right after spinal anesthesia until end of surgery)
Secondary mean pH of the fetal cord blood in each group fetal cord blood analysis will be done immediately after delivery in order to determine the pH value ( ie: logarithm of the blood concentration of hydrogen ions H+)in each group At time of birth
Secondary Nausea cesarean section with an infusion of either Ephedrine or Norepinephrine. Measure will be done according to a simple scale: 0= no nausea; 1= nausea At time of surgery (right after spinal anesthesia until end of surgery)
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