Different Doses of Ropivacaine either with Sufentanil or with Dexmedetomidine for Labor Epidural Anesthesia regarding Painless Childbirth: A Retrospective, Multicenter Study

Abstract

<b><i>Introduction:</i></b> Sufentanil is used with ropivacaine in labor pain management but it can have respiratory depression. Dexmedetomidine is effective to maintain hemodynamic stability in parturient women and allow awake intubation. However, dexmedetomidine is suggested only in patients with major cardiovascular disease that mandates stable hemodynamics (Reference ID: 3987541-USFDA). The objective of the study was to compare different doses of ropivacaine either with sufentanil or with dexmedetomidine for epidural anesthesia regarding labor pain management. <b><i>Methods:</i></b> Parturient women have received 0.125% ropivacaine with 0.5-μg/mL sufentanil (SR1 cohort, <i>n</i> = 115), or 0.08% ropivacaine with 0.5-μg/mL sufentanil (SR2 cohort, <i>n</i> = 109), or 0.125% ropivacaine with 0.5-μg/mL dexmedetomidine (DR1 cohort, <i>n</i> = 124), or 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine (DR2 cohort, <i>n</i> = 135) for epidural anesthesia during vaginal delivery or cesarean section. <b><i>Results:</i></b> At 2-h postpartum, the visual analog scale score of parturient women of the DR2 cohort was fewer than that of parturient women of the SR1 (<i>p</i> < 0.0001, <i>q</i> = 4.162) and the SR2 (<i>p</i> < 0.0001, <i>q</i> = 7.568) cohorts and statistically the same as that of parturient women of the DR1 cohort (<i>p</i> < 0.0001, <i>q</i> = 3.087). Bradycardia and itching were reported in parturient women of the DR2 and the DR1 cohorts while nausea, vomiting, and urinary retention at 6 h were reported in parturient women of the SR1 and the SR2 cohorts. In the DR2 cohort, there were fewer numbers of parturient women with bradycardia (4 vs. 19, <i>p</i> < 0.0001, <i>q</i> = 6.613) and hypotension (2% vs. 1%) than those in the DR1 cohort. The child born by women of the DR2 cohort had high partial arterial pressure of oxygen than those born by women of the DR1 (<i>p</i> < 0.0001, <i>q</i> = 18.663), the SR1 (<i>p</i> < 0.0001, <i>q</i> = 29.366), and the SR2 (<i>p</i> < 0.0001, <i>q</i> = 24.039) cohorts. <b><i>Discussion/Conclusion:</i></b> Epidural 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine is an effective and safe anesthetic regimen for hypertensive parturient women and their newborns. <b><i>Level of Evidence:</i></b> III. <b><i>Technical Efficacy Stage:</i></b> 4.

Efficacy and safety of different doses of epidural morphine coadministered with low-concentration ropivacaine after cesarean section: A retrospective cohort study

“…Low-concentration of ropivacaine coadministered with opioid including morphine has been a common protocol used in epidural analgesia after CS ( Zhang et al, 2021 ; Wang et al, 2022 ). Adding morphine to epidural local anesthetics can effectively enhance the analgesia effect and concomitantly reduce the incidence of adverse reactions caused by local anesthetics.…”

The Influence of Adjuvants on the Expression of Pro-Inflammatory Cytokines During Spinal Anesthesia

“…Клінічні дослідження підтвердили, що місцеві анестетики у поєднанні з опіоїдами та ад'ювантами можуть відігравати синергетичну роль у знеболюванні, зменшити дозу анестетиків, стабілізувати гемодинаміку та зменшити побічні реакції, спричинені знеболюючими препаратами [12].…”

The Beneficial Effect of Dexmedetomidine Combined With Epidural-Controlled Analgesia on the Reduction of Fever and Inflammation During Labour in Term-Pregnant Women

“…Effective labour analgesia can ensure the smooth delivery of women and the safety of new-borns. Ropivacaine is the most commonly used drug for epidural labour analgesia in clinical practice and has the advantages of a low placental transfer rate, a small foetal impact, and a good anaesthetic analgesia effect [16,17]. However, large doses of ropivacaine can affect maternal and infant health, and small doses of ropivacaine have poor analgesic effects [18].…”