ED&lt;sub&gt;50&lt;/sub&gt; of intrathecal ropivacaine for cesarean delivery with and without epidural volume extension with normal saline: a randomized controlled study.

Lv, Meng-Dan; Zhang, P; Wang, Z

doi:10.2147/jpr.s174176

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…However, the minimum epidural saline volume that affects the level of sensory block under spinal anesthesia is 7.3 mL (95% CI, 5.5-9.9 mL). 16 Therefore, the epidural administration of 3mL of saline does not have a significant effect on the results, and if it does, it is to reduce the dose of ED 50 , 17 which narrow the difference in dose between the two studies.…”

Section: Discussionmentioning

confidence: 99%

The Median Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Section at Moderately High-Altitude

Yang,

Dong,

Luo

et al. 2024

DDDT

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Alterations in altitude can lead to an augmented requirement for local anesthesia among patients. Nevertheless, the necessity for an elevated dosage of local anesthetic for parturients at moderately high altitudes during spinal anesthesia for cesarean section remains uninvestigated. This up-down sequential study endeavors to determine the ED 50 dose of bupivacaine required for spinal anesthesia during cesarean sections at moderately high-altitude. Methods: Thirty singleton parturients at moderately high altitude underwent elective cesarean section under combined spinal-epidural anesthesia. The up-and-down sequential method was employed, starting with an initial dose of 12mg (1.6mL) of 0.75% hyperbaric bupivacaine for the first participant. The dose for the next case was adjusted up or down by 0.75mg based on the effectiveness of the previous participant. Effectiveness was defined as the bilateral sensory block reaching T6 within 15 minutes after spinal anesthesia injection, without the need for additional epidural anesthesia before fetal delivery. The ED 50 dose and 95% confidence interval were calculated using the Dixon sequential method and isotonic regression, respectively. The incidence of maternal hypotension, nausea, and vomiting during the study period was also recorded. Results:The ED 50 of hyperbaric bupivacaine for spinal anesthesia in cesarean section was calculated as 8.23 mg (95% CI, 6.52-9.32 mg) using the Dixon up-and-down method. Further validation using isotonic regression yielded a value of 8.39 mg (95% CI, 7.48-9.30 mg), confirming the accuracy and sensitivity of the conclusion. During the operation, only 6 parturients experienced hypotension, and no adverse reactions such as nausea, vomiting, and shivering were observed. Conclusion:The ED 50 dose of 0.75% hyperbaric bupivacaine for spinal anesthesia during cesarean section at moderately high altitude is 8.23 mg, which exceeds the ED 50 dose typically required by parturients at low altitude. Comprehensive investigations are warranted to ascertain the ED 90 or ED 95 dose of local anesthetics for cesarean section at moderately high altitudes, thereby offering enhanced guidance for clinical practice.

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Section: Discussionmentioning

confidence: 99%

The Median Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Section at Moderately High-Altitude

Yang,

Dong,

Luo

et al. 2024

DDDT

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“…Mei et al showed that the ED50 and ED95 of hyperbaric ropivacaine for cesarean section were 11mg and 15mg, 17 and the sequential study of Lv et al showed that the ED50 of hyperbaric ropivacaine for cesarean section was 8.29mg. 18 Practically, due to high abdominal pressure and distended intraspinal veins, the drug dose required for spinal anesthesia for puerperae is lower than that of non-puerperae women. However, the dose in the above study was still significantly higher than the ED50 and ED95 of 7.036 mg and 8.709 mg in this study.…”

Section: Discussionmentioning

confidence: 99%

Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study

Wang¹,

Zha²,

Fang³

et al. 2022

CIA

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Objective The dose selection of ropivacaine for spinal anesthesia in clinical work mainly depends on the experience of the anesthesiologist. In this study, a prospective and modified up-down sequential allocation design was used to provide the optimal dose selection of ropivacaine for spinal anesthesia. Patients and methods This study was divided into two stages, and a total of 164 elderly patients with elective hip fractures were included. In stage I, the dose of ropivacaine was selected using the up-down sequential method of height correction, and the 50% effective dose (ED50) and 95% effective dose (ED95) were obtained. A nomogram for predicting satisfactory anesthesia and a formula for predicting the optimal dose was also given in this stage. In stage II, the dose of ropivacaine was calculated by using the optimal dose prediction formula, so as to evaluate the efficacy and safety of the model. Results The ED50 and ED95 of the stage I were 7.036 mg (95%CI 6.549–7.585 mg) and 8.709 mg (95%CI 7.902–14.275 mg), respectively. And provided a nomogram predicting satisfactory anesthesia with a C-index of 0.847 (95%CI 0.774–0.92). The optimal dose prediction formula of ropivacaine was calculated, including variables for age, gender, height, and weight. This formula was found to be 90% efficient. It is worth mentioning that the incidence of direct transfer to the ward in the two stages was as high as 86.84% and 93.33%, respectively, and no patients were transferred to the ICU in stage II. Conclusion The ED50 and ED95 of ropivacaine were 7.036 mg and 8.709 mg, respectively, and the nomograms are sufficiently accurate to predict satisfactory anesthesia. Beyond that, the dose prediction equation provided in this study has high efficacy and safety, and can guide the dose selection of spinal anesthesia in elderly patients with hip fracture in clinical practice. Clinical trials registration ChiCTR2100046982

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“…Although ropivacaine has more stable hemodynamics effect, it might induce hypotension in SA, especially with high doses in obese parturient women [7]. Thus small dose of local anesthestic was advocated due to low incidence of hypotension induced by SA, however it possibly increased the failures [8,9]. In some cases phenylephrine has to be administered because of its' more advantages to prevent SA related to hypotension [5,10].…”

mentioning

confidence: 99%

"The Clinical Effects of Epidural Anethesia with Lidocaine Combined Low Dose Ropivacaine in Elective Cesarean Section"

Wang¹,

Bao²,

Xiong

2021

BJSTR

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Objective: To observe the effects of epidural anesthesia with lidocaine combined low dose ropivacaine in elective cesarean section, and to provide more effective and simple anesthetic methods for obstetrics.Methods: 60 women undergoing elective cesarean section were randomly divided into two groups, combined spinal-epidural anesthesia group (CSEA group, n=27), and lidocaine and ropivacaine group (LR group, n=33). Combined spinal-epidural anesthesia with hyperbarci ropivacaine was used in CSEA group, and epidural anesthesia with lidocaine combined low dose ropivacaine was used in LR group. Monitoring and recording basic SBP, DBP and HR of all cases (T0). The lowest SBP, DBP and the fastest HR were recorded (T1), and the SBP, DBP and HR of 30min after anesthesia (T2) were recorded too. The anesthetic effects were evaluated by Anesthetic Effect Score and modified Bromage score. Meanwhile adverse reactions were recorded.Results: There was no difference on SBP, DBP and HR of T0 and T2 of two groups (P>0.05). Compared to CSEA group, SBP and DBP of T1 of LR group were increased significantly (P<0.05), and HR of T1 in two group was similar (P>0.05). The lowest SBP in both groups were on T1, the highest SBP of two groups were on T0, following T2. DBP and HR in two groups on T0 and T2 were similar. But DBP on T1 was the lowest in two group, and HR on T1 was the highest in two groups. There was no difference on Anesthetic Effect Score in two groups. Compared to CSEA group, modified Bromage score of LR group was reduced significantly at the end of anesthesia and the end of operation (P<0.05). Compared to CSEA group, the duration of anesthesia manuevre was reduced significantly, meanwhile, the onset of operation was reduced significantly (P<0.05). The cases of nausea were significantly reduced in LR groups compared to CSEA group (P<0.05). The scores of Apgar of two groups in 1min and 5min were indifferent (P>0.05). Conclusion:The clinical effect of epidural anesthesia with lidocaine combined low dose ropivacaine was reliable. With this anesthesia, circulation of maternity was more stable, adverse reaction and the extents of movement blocked were reduced too. So it was more effective and simple anesthesia method for cesarean section.

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ED<sub>50</sub> of intrathecal ropivacaine for cesarean delivery with and without epidural volume extension with normal saline: a randomized controlled study.

Cited by 6 publications

References 19 publications

The Median Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Section at Moderately High-Altitude

The Median Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Section at Moderately High-Altitude

Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study

"The Clinical Effects of Epidural Anethesia with Lidocaine Combined Low Dose Ropivacaine in Elective Cesarean Section"

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