Adverse Events of Peripherally Administered Norepinephrine During Surgery: A Prospective Multicenter Study

Area of Science:

• Anesthesiology and Critical Care Medicine
• Pharmacology and Therapeutics

Background:

• Peripheral intravenous administration of norepinephrine for hypotension during surgery carries a risk of adverse events, including tissue necrosis.
• The actual incidence and severity of these adverse events in the perioperative period are not well-established.

Purpose of the Study:

• To prospectively evaluate the incidence and severity of adverse events associated with perioperative peripheral norepinephrine administration.
• To identify risk factors for adverse events during this treatment.

Main Methods:

• A prospective observational study involving 1004 patients receiving perioperative peripheral norepinephrine across 3 Swedish hospitals (2019-2022).
• Regular inspection of infusion sites, with immediate changes for signs of swelling or paleness.
• Monitoring of blood pressure and pulse rate, defining adverse events as systolic blood pressure >220 mm Hg or pulse <40 beats/min.

Main Results:

• The prevalence of extravasation was 2.3% (95% CI, 1.4%-3.2%), and bradycardia occurred in 0.9% (95% CI, 0.4%-1.7%).
• No cases of tissue necrosis or severe hypertension were observed.
• Proximal catheter placement was associated with an increased risk of adverse events. All events resolved spontaneously within 48 hours.

Conclusions:

• Peripherally administered norepinephrine in the perioperative period resulted in extravasation rates comparable to those in critically ill patients.
• A proactive approach involving regular infusion site inspection and timely repositioning effectively mitigated severe adverse events.
• While this preventive strategy appears safe, further validation in larger patient cohorts is warranted to confirm its benefits.