Objective: The optimal concentration of ropivacaine as epidural labor analgesia combined with sufentanil has not been established. This study aimed to determine the median effective concentration (EC50) of epidural ropivacaine for labor analgesia in healthy term pregnancy when co-administered with sufentanil as an adjuvant or alone. Patients and Methods: Sixty healthy parturients scheduled for epidural labor analgesia were enrolled in the study. They were divided into a saline group (Group C) and an epidural sufentanil (0.5 µg/mL) group (Group S). The initial concentration of ropivacaine was set at 0.125%, which was then varied by 0.01% using the up-and-down sequential allocation method. The hemodynamics were continuously monitored during delivery. A visual analog scale was used to evaluate the degree of pain. The Ramsay sedation score, duration of the labor stages, the onset of epidural analgesia, and adverse effects were recorded. Neonatal outcomes were evaluated using the Apgar scores and umbilical artery blood gas analysis. Results: The EC50 of ropivacaine was 0.085% (95% CI, 0.079-0.090%) in Group S and 0.109% (95% CI, 0.105-0.112%) in Group C. The EC95 of ropivacaine was 0.096% (95% CI, 0.090-0.118%) in Group S, and 0.116% (95% CI, 0.113-0.127%) in Group C. The difference between the groups was statistically significant (p < 0.001). The stable hemodynamics, satisfactory analgesia, and good neonatal outcomes were comparable in both groups (P > 0.05). Conclusion:The EC50 of ropivacaine was reduced by 22% when co-administered with sufentanil for epidural labor analgesia in primipara. (www.chictr.org.cn; registration number: ChiCTR2000039547).

Background The analgesic effects of erector spinae plane block in general anesthesia for cesarean section and recovery from puerperae remain unclear. Methods Sixty patients with contraindications for spinal anesthesia who required general anesthesia for cesarean section were enrolled and randomly divided into the erector spinal plane block (ESPB) combined with the general anesthesia group (group E) and general anesthesia group (group G). Group E received bilateral ESPB (20 ml of 0.25% ropivacaine on each side) under ultrasound guidance 30 min before general anesthesia. The primary outcomes were the number of patient-controlled intravenous analgesia (PCIA) boluses, and Bruggemann comfort scale (BCS) scores at 2 h, 6 h, 12 h, and 24 h after operation. The second outcome was intraoperative anesthesia dosage, fetal delivery time, puerperae emergence time, visual analog scale (VAS) at 2 h, 6 h, 12 h, and 24 h after operation, and incidence of nausea and vomiting. Heart rate (HR) and mean arterial pressure (MAP) were recorded 10 min before the start of anesthesia (T0), at the induction of anesthesia (T1), at skin incision (T2), and fetal delivery (T3), and immediately after surgery (T4). Results The number of PCIA boluses was lower in group E than in group G (P < 0.001). The BCS score increased at 2 h and 6 h after the operation in group E (P < 0.05), while the VAS score significantly decreased in group E at the same time (P < 0.05). Compared with group G, the doses of propofol and remifentanil were significantly decreased in group E (P < 0.001), the emergence time of puerperae was shortened (P = 0.003), and the incidence of nausea and vomiting was significantly decreased (P = 0.014). Conclusion Ultrasound-guided ESPB applied to general anesthesia for a cesarean section can significantly reduce the required dose of general anesthetic drugs, shorten the recovery time of the puerperae, and improve postoperative analgesia. Trial registration:www.clinicaltrials.gov under the number ChiCTR2200056337 (04–02-2022).

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Background: The analgesic effects of the erector spinae plane block in general anesthesia for cesarean section and the recovery from puerperae remain unclear.Methods: Sixty patients with contraindications for spinal anesthesia who required general anesthesia for cesarean section were enrolled and randomly divided into the erector spinal plane block (ESPB) combined with general anesthesia group (group E) and the general anesthesia group (group G). Group E received bilateral ESPB (20 ml of 0.25% ropivacaine on each side) under ultrasound guidance 30 min before general anesthesia. The heart rate (HR), mean arterial pressure (MAP) were recorded 10 min before the start of anesthesia (T0), at the induction of anesthesia (T1), at skin incision (T2), fetal delivery (T3), and immediately after surgery (T4). Intraoperative anesthesia dosage, fetal delivery time, and puerperae emergence time were also recorded. Visual analog scale (VAS) and Bruggrman comfort scale (BCS) scores at 2h, 6h, 12h, and 24h after operation were compared between the two groups. Number of patient-controlled intravenous analgesia (PCIA) boluses, and adverse reactions were also recorded.Results: The MAP and HR of T2 and T3 in group G were significantly increased compared with T1 (P<0.05), as well as with those in group E at the same time point (P<0.05); compared with group G, the doses of propofol and remifentanil were significantly reduced (P<0.0001), the emergence time of the puerpera was shortened (P=0.003), the VAS score at 2h and 6h after the operation was reduced, the BCS score was increased (P<0.05), the number of PCIA boluses was reduced (P<0.001), and the incidence of nausea and vomiting significant decreased (P=0.014).Conclusion: Ultrasound-guided ESPB applied to general anesthesia for cesarean section can significantly reduce the required dose of general anesthetic drugs, shorten the recovery time of puerperae, and improve postoperative analgesia.