Combined Use of Hyperbaric and Hypobaric Ropivacaine Significantly Improves Hemodynamic Characteristics in Spinal Anesthesia for Caesarean Section: A Prospective, Double-Blind, Randomized, Controlled Study

Quan, ZheFeng; Tian, Mei; Chi, Ping; Li, Xin; He, Huawei; Luo, Chao

doi:10.1371/journal.pone.0125014

Cited by 13 publications

(11 citation statements)

References 35 publications

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“…In China, some hospitals and centers use ropivacaine for spinal anesthesia . Ropivacaine is a type of long‐acting LA that induces a less intense and shorter‐duration motor block than bupivacaine, enabling early movement after cesarean section.…”

Section: Introductionmentioning

confidence: 99%

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Shen

Zhang

et al. 2016

J of Obstet and Gynaecol

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Section: Introductionmentioning

confidence: 99%

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Shen

Zhang

et al. 2016

J of Obstet and Gynaecol

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“…According to anatomical structure, for cesarean section, it is recommended that the highest sensory block level should reach dermatome level dominated by the fourth thoracic nerve (T4) (23). However, in different studies, the highest sensory block level is required to reach T4, T5, T6, or T8 (5,14,20,(24)(25)(26). In some parturients, even though the highest sensory block level reaches T4, they still feel slight pain (23).…”

Section: Interventionmentioning

confidence: 99%

“…In our clinical practice, when the highest sensory block level reaches T8 at 10 min after anesthesia, the anesthesia is adequate. Therefore, at 10 min after anesthesia, if the sensory block level did not reach T8, spinal anesthesia was regarded as a failure (24,25). The parturients without successful spinal anesthesia were excluded from the study.…”

Section: Interventionmentioning

confidence: 99%

“…The parturients without successful spinal anesthesia were excluded from the study. For parturients without successful spinal anesthesia, 2% lidocaine + 0.75% ropivacaine (15 ml) was given via epidural space until the level of sensory block is not lower than T8 (24,25) or the anesthetic technique was changed to general anesthesia. For parturients with successful spinal anesthesia, when the parturients felt pain after taking out the fetus, fentanyl (0.1 mg) via a vein and/or 2% lidocaine + 0.75% ropivacaine (15 ml) via the epidural space were carried out.…”

Section: Interventionmentioning

confidence: 99%

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A Height-Based Dosing Algorithm of Bupivacaine in Spinal Anesthesia for Decreasing Maternal Hypotension in Cesarean Section Without Prophylactic Fluid Preloading and Vasopressors: A Randomized-Controlled Non-Inferiority Trial

et al. 2022

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BackgroundThere is a high incidence of maternal hypotension in spinal anesthesia for cesarean section. The aim of the study is to investigate whether there is a height-based dosing algorithm of bupivacaine that provides adequate anesthesia with less maternal hypotension.MethodsThere were 2 groups of 280 parturients who did not receive prophylactic fluid preloading: Test and Conventional group. In Test group, a height based dosing algorithm was used to confirm the dose of bupivacaine in parturients without prophylactic vasopressors. In the Conventional group, a constant dose of bupivacaine was used. The complications and quality of anesthesia were evaluated.ResultsIn the Conventional group, the shorter participants had higher incidence of hypotension, faster sensory block time, and more participants with complete motor block (p = 0.030, 2.957 × 10−14, and 0.012). In the Test group, the incidence of hypotension, sensory block time, and number of participants with complete motor block did not change with height (p = 0.199, 0.617, and 0.209). The height-based dosing algorithm of bupivacaine decreased the incidence of hypotension (p = 0.004), induced lower sensory block level and less degree of motor block (p = 3.513 × 10−7 and 5.711 × 10−11). The quality of analgesia, quality of muscle relaxation, and degree of intraoperative comfort were similar in both groups (p = 0.065, 0.498, and 0.483).ConclusionsThe height influences the dose of bupivacaine in spinal anesthesia; without prophylactic fluid pre-loading and vasopressors, the height-based dosing algorithm of bupivacaine is suitable, and meets the cesarean section' requirement with less maternal hypotension.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03497364.

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“…On the other hand, the most important cause of heat redistribution from the core to the periphery due to vasodilation is the induction of general or neuraxial anesthesia [ 13 ]. According to the efficacy of local anesthetics, bupivacaine and ropivacaine are most widely used in spinal anesthesia [ 14 , 15 ]. All of these point together towards a need for a comprehensive understanding of the relationship between hypothermia, core temperature change, local anesthetics, and shivering.…”

Section: Introductionmentioning

confidence: 99%

The relationship between core temperature and perioperative shivering during caesarean section under intrathecal anesthesia with bupivacaine and ropivacaine: a randomized controlled study

et al. 2021

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Purpose To assess the incidence rate of perioperative shivering for cesarean section and explore the associations between the occurrence of shivering and hypothermia, core temperature change, local anesthetic. Methods This is a prospective, randomized, controlled, double-blinded study of 100 patients consenting for caesarean section under intrathecal anesthesia. Parturients with ASA I or II accepted elective caesarean section with combined spinal-epidural anesthesia (SA). 2–2.5 ml of 0.5% bupivacaine or 0.5% ropivacaine was intrathecally injected in group B and group R, respectively. Results The intraoperative shivering incidence in group B was significantly higher than that in group R (66.7 vs. 20.5%, Pvalue < 0.001), and shivering intensity in group B was significantly greater than group R (score: 1.4 vs. 0.3, Pvalue < 0.001). The core temperature in both groups gradually decreased with the time after SA. Hypothermia (core temperature < 36.0 ℃) 5–30 min after SA was not associated with shivering. However, changes of temperature at 25 and 30 min after SA, and bupivacaine were statistically associated with shivering, with the odds of 10.77 (95% CI: 1.36–85.21, P value = 0.02), 8.88 (95% CI: 1.29–60.97, P value = 0.03), and 7.78 (95% CI: 2.94–20.59, P value < 0.01), respectively. Conclusions In our study, for cesarean section, the occurrence of shivering was associated with the local anesthetics and the change of core temperature after SA, while not the hypothermia.

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Combined Use of Hyperbaric and Hypobaric Ropivacaine Significantly Improves Hemodynamic Characteristics in Spinal Anesthesia for Caesarean Section: A Prospective, Double-Blind, Randomized, Controlled Study

Cited by 13 publications

References 35 publications

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

A Height-Based Dosing Algorithm of Bupivacaine in Spinal Anesthesia for Decreasing Maternal Hypotension in Cesarean Section Without Prophylactic Fluid Preloading and Vasopressors: A Randomized-Controlled Non-Inferiority Trial

The relationship between core temperature and perioperative shivering during caesarean section under intrathecal anesthesia with bupivacaine and ropivacaine: a randomized controlled study

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