Superiority of Phenylephrine Versus Norepinephrine in Complex Spine Surgery (SPiNeS)

Superiority of Phenylephrine Versus Norepinephrine in Complex Spine Surgery (SPiNeS): A Prospective Randomized Superiority Trial

The purpose of this research is to compare two commonly used medications, phenylephrine and norepinephrine, that are used to treat low blood pressure during complex spine surgery. The goal is to determine whether one medication better maintains blood flow to the body's organs during surgery and whether it leads to better recovery and fewer complications after surgery.

Inclusion Criteria:

• Scheduled for elective complex spine surgery including posterior fusion of 5 or more levels of the thoracic and/or lumbar region.
• ASA physical status classification I-III.
• Able to provide informed consent.

Exclusion Criteria:

• Known allergies or contraindication to NE or PE.
• Pregnant or breastfeeding women.
• Emergency surgeries.
• Persistent atrial fibrillation
• LVEF < 40%
• Moderate or severe valvular dysfunction
• RVSP ≥ 60 mm Hg
• Liver failure or cirrhosis
• eGFR < 15 and/or on hemodialysis
• Minimally invasive or endoscopic surgeries