Intrathecal sufentanil decreases the median effective dose (ED50) of intrathecal hyperbaric ropivacaine for caesarean delivery

Chen, X; Qian, Xiaowei; Fu, Feng; Lu, H.; Bein, Berthold

doi:10.1111/j.1399-6576.2009.02051.x

Cited by 41 publications

(49 citation statements)

References 28 publications

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“…Unexpectedly, the present study demonstrated that the ED 50 of intrathecal bupivacaine for cesarean delivery in the Magnesium group was not reduced when compared with the Control group, suggesting that intrathecal 50 mg magnesium sulfate exhibits little or no effect on efficacy of spinal anesthesia with local anesthetics for cesarean delivery. In contrast to the lack of effect of magnesium on the median effective dose of intrathecal bupivacaine in the current study, previous studies suggested that intrathecal fentanyl or sufentanil significantly reduce the dose (ED 50 or ED 95 ) of spinal local anesthetics for cesarean delivery [3, 29, 30]. The possible underlying mechanism is that magnesium may be removed from extracellular fluid more rapidly than opioids, or that it may be specific to the NMDA receptor channel and therefore has no influence on the channels the local anesthetics act and opioid receptor sites [14, 17].…”

Section: Discussioncontrasting

confidence: 81%

“…The main limitations of spinal anesthesia are the relatively short duration of anesthesia and analgesia, and high incidence of hypotension. To minimize these limitations, intrathecal adjuncts such as opioids, clonidine, neostigmine and epinephrine have been reportedly used for prolonging analgesia and reducing the dose of intrathecal local anesthetic, and subsequently reducing the incidence of spinal anesthesia-induced hypotension [3–5]. However, intrathecal opioids such as fentanyl and sufentanil, which are commonly used as adjuncts to intrathecal local anesthetic, are associated with a number of undesirable side-effects, including delayed respiratory depression, urinary retention, and pruritus [6–8].…”

Section: Introductionmentioning

confidence: 99%

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Intrathecal magnesium sulfate does not reduce the ED50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method

Xiao

Xu²,

Feng

et al. 2017

BMC Anesthesiol

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BackgroundAddition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery.MethodsSixty healthy parturients undergoing scheduled cesarean delivery were randomly assigned to receive spinal anesthesia with 0.5% hyperbaric bupivacaine and 5 μg sufentanil with either 0.9% sodium chloride (Control group) or 50% magnesium sulfate (50 mg) (Magnesium group). Effective anesthesia was defined as a bilateral T5 sensory block level achieved within 10 min of intrathecal drug administration and no additional epidural anesthetic was required during surgery. Characteristic of spinal anesthesia and the incidence of side effects were observed. The ED50 for both groups was calculated using the Dixon and Massey formula.ResultsThere was no significant difference in the ED50 of bupivacaine between the Magnesium group and the Control group (4.9 mg vs 4.7 mg) (P = 0.53). The duration of spinal anesthesia (183 min vs 148 min, P < 0.001) was longer, the consumption of fentanyl during the first 24 h postoperatively (343 μg vs 550 μg, P < 0.001) was lower in the Magnesium group than that in the Control group.ConclusionsIntrathecal magnesium sulfate (50 mg) did not reduce the dose requirement of intrathecal bupivacaine, but can extend the duration of spinal anesthesia with no obvious additional side effects.Trial registrationThis study was registered with Chinese Clinical Trial Registry (ChiCTR) on 15 Jul. 2014 and was given a trial ID number ChiCTR-TRC-14004954.

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Section: Discussioncontrasting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Intrathecal magnesium sulfate does not reduce the ED50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method

Xiao

Xu²,

Feng

et al. 2017

BMC Anesthesiol

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“…Several studies have been conducted to elucidate the efficacy of intrathecal ropivacaine with adjuvants such as fentanyl (Chung et al, 2002) and sufentanil (Sun et al, 2001;Chen et al, 2010) in cesarean delivery. But intrathecal opioids will increase nausea and vomiting (Weigl et al, 2017) and itching (Sun et al, 2001;Chen et al, 2010;Sun et al, 2017) that is an uncomfortable experience and prolong the recovery for the parturients after the surgery.…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

Zhang

et al. 2020

Front. Pharmacol.

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In this study, we aim to investigate the effect of different doses of dexmedetomidine as an adjuvant to hyperbaric ropivacaine in spinal anesthesia for cesarean section. Methods: Seventy-five parturients with American Society of Anesthesiologists (ASA) I or II were anesthetized with intrathecal ropivacaine (12.5 mg) alone (R group) or in combination with dexmedetomidine 3 mg (RD3 group) and 5 mg (RD5 group) to undergo a cesarean section. The anesthetic parameters, postoperative analgesia, stress responses and neonates outcomes were monitored. Results: The onset time of sensory block to T10, T4, and peak level in the RD3 group and RD5 group were significantly shorter than those in the R group (p < 0.05). The time of the level of sensory block to descend two segments and to T10 in the RD3 group(57.28 ± 16.65 min, 3.87 ± 1.60 h) and RD5 group (71.92 ± 10.10 min, 3.99 ± 1.06 h) were longer than that in the R group (40.64 ± 12.06 min, 1.98 ± 1.01 h) (p < 0.05). The median time of motor blockade to both legs score 3 on the Bromage scale (B3B3) in the RD3 group and RD5 group was shorter than that in the R group (p < 0.001). The time of motor blockade recovery to both legs score 0 on the Bromage scale (B0B0) in the RD5 group (3.6 h) was longer than that in the R group (2 h) or RD3 group (2.2 h) (p < 0.001). Visceral traction response and abdominal muscle relaxation during the operation in the RD3 group and the RD5 group were better than that in the R group. The Visual Analogue Score (VAS) in the 12 h after the operation in the RD3 group (3.30 ± 1.17) and RD5 group (2.80 ± 0.87) was smaller than that in the R group (3.80 ± 1.47) (p < 0.05). The incidence of shivering in the RD3 group and RD5 group was significantly lower than that in the R group (p < 0.05). The postoperative concentrations of c-reactive protein (CRP), interleukin-6 (IL-6) and cortisol in the RD3 and RD5 groups were lower than that in the R group (p < 0.05). Conclusion: 3 µg intrathecal dexmedetomidine as an adjuvant to ropivacaine improved intraoperative somato-visceral sensory block characteristics and postoperative analgesia,

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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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Intrathecal sufentanil decreases the median effective dose (ED50) of intrathecal hyperbaric ropivacaine for caesarean delivery

Abstract: Intrathecal sufentanil 5 microg produced a 28% reduction of ED50 of intrathecal hyperbaric ropivacaine for caesarean delivery.

Cited by 41 publications

References 28 publications

Intrathecal magnesium sulfate does not reduce the ED50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method

Intrathecal magnesium sulfate does not reduce the ED50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

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

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