The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

Xiao, Fei; Xu, Wenping; Zhang, Yinfa; Liu, Lin; Liu, Xia; Wang, Lizhong

doi:10.4103/0366-6999.166036

Cited by 11 publications

(11 citation statements)

References 30 publications

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“…Ropivacaine has strong reactivity with α1-acid glycoprotein in the human body (26), which may further ensure fetal safety and reduce the need for surgery. This is also consistent with the results of Xiao et al (27). Ropivacaine is a long-acting amide local anesthetic with a stronger ability to inhibit nerve conduction in pain-sensing fibers, but it has a lesser effect on the central nervous system and the cardiovascular system (18).…”

Section: Discussionsupporting

confidence: 92%

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

Cheng

Zhang

et al. 2019

Exp Ther Med

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The present study aimed to investigate and compare the analgesic effect and safety of ropivacaine or levobupivacaine in combined spinal-epidural anesthesia during childbirth and their effects on neonatal Apgar scores, as well as maternal and neonatal vital signs. A total of 615 maternal patients undergoing labor between April 2016 and March 2017 were divided into two groups according to the analgesic used for combined spinal-epidural anesthesia during childbirth: The ropivacaine group (n=318) and the levobupivacaine group (n=297). The onset time of analgesia in the two groups was determined and the pain score on the visual analog scale was assessed at the time of delivery (T3). At pre-analgesia, 30 min after analgesia (T2), at T3 and during maternal wound suturing (T4), the systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were assessed. The cesarean section rate, neonatal 1-and 5-min Apgar scores and neonatal asphyxia at T4 were also determined. The onset time of analgesia in the ropivacaine group was significantly reduced compared with that in the levobupivacaine group (P<0.05). At T2 and T4, the SBP was significantly higher in the levobupivacaine group than that in the ropivacaine group (P<0.05). At T2, T3 and T4, the DBP was significantly lower in the levobupivacaine group compared with those in the ropivacaine group (P<0.05). At T2, the HR was significantly lower in the levobupivacaine group than that in the ropivacaine group (P<0.05). The cesarean section rate was significantly lower in the ropivacaine group compared with that in the levobupivacaine group [4.09% (n=13) vs. 22.89% (n=68); P<0.01]. In conclusion, the use of combined spinal-epidural anesthesia with ropivacaine or levobupivacaine has an excellent analgesic effect during childbirth. However, compared with levobupivacaine, ropivacaine for labor analgesia had a faster onset and a lesser impact on maternal vital signs, and was associated with a reduced maternal cesarean section rate among patients who did not opt for cesarean section in the beginning; therefore, it is useful in clinical practice.

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Section: Discussionsupporting

confidence: 92%

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

Cheng

Zhang

et al. 2019

Exp Ther Med

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“…Therefore, we believed that results would be not comparable between the 2 studies. Fortunately, in Xiao and his colleagues study, whose study protocol was similar to this study, they found ED 50 and ED 95 of intrathecal hyperbaric ropivacaine of successful spinal anesthesia (operation) for cesarean section in parturients without receiving prophylactic infusion of phenylephrine were 8.28 mg and 12.24 mg respectively, [19] whereas in our present study the ED 50 and ED 95 of intrathecal hyperbaric bupivacaine were 9.9 mg and 15.2 mg respectively, which was higher than Xiao results. By the comparison, it could demonstrate that a higher dose of intrathecal ropivacaine is needed when we choose prophylactic phenylephrine infusion to prevent spinal-induced hypotension.…”

Section: Discussionsupporting

confidence: 52%

ED50 and ED95 of intrathecal hyperbaric ropivacaine for parturients undergoing cesarean section with prophylactic infusion of phenylephrine

Xiao²,

Zhang³

et al. 2018

Medicine

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Background:Studies have reported that the ED50 of intrathecal ropivacaine was increased when using prophylactic infusion of phenylephrine to prevent spinal-induced hypotension. However, ED95 is more meaningful to clinical practice than ED50. Therefore, we conducted this study to determine the 95% effective dose (ED95) of intrathecal hyperbaric ropivacaine for cesarean section in parturients receiving prophylactic infusion of phenylephrine to prevent spinal-induced hypotension.Methods:A hundred of healthy parturients undergoing elective cesarean section under combined spinal-epidural anesthesia (CSEA) were enrolled in this randomized, double-blinded, dose-ranging study. Patients were randomly assigned to receive 7, 9, 11, 13 or 15 mg intrathecal hyperbaric ropivacaine respectively. The prophylactic phenylephrine infusion (50 μg/min) was initiated immediately at the same time of spinal injection. Successful spinal anesthesia was defined as a T5 sensory level achieved within 10 min after intrathecal drug administration and no epidural supplement was required during the surgery. The ED95 was calculated with Probit analysis.Results:The ED95 of intrathecal ropivacaine with 5 μg sufentanil for successful anesthesia was 15.2 mg (95%CI, 13.5–18.8 mg), when receiving prophylactic infusion of phenylephrine.Conclusion:Under the conditions of the present study, the ED95 of intrathecal hyperbaric ropivacaine for successful spinal anesthesia for cesarean section in healthy parturient receiving prophylactic infusion of phenylephrine was 15.2 mg.

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“…[15] However in their study, they used 0.75% isobaric ropivacaine whereas, we used 0.5% isobaric ropivacaine. In a similar study done by Tadeusz et al [16] in Poland and Fei Xiao et al [17] in China, the MLADs of intrathecal ropivacaine and bupivacaine for cesarean delivery were reported 9.45mg and 7.33 respectively. These results are consistent with the present study with only difference that they performed spinal anesthesia in L2-3 space whereas we performed in L3-4 space.…”

Section: Discussionmentioning

confidence: 61%

Minimal Local Analgesic Dose of Intrathecal Bupivacaine and Ropivacaine in Patients Undergoing Cesarean Section: A Comparative Study

Singh¹,

Shrestha²,

Kharbuja³

et al. 2019

J Lumbini Med Coll

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Introduction: Spinal anesthesia is a reasonable option for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opiods. Ropivacaine is considered a valid and safe alternative to bupivacaine for intrathecal anesthesia. This study aims to determine the median effective dose (ED50) of intrathecal bupivacaine and ropivacaine for cesarean section and defines this as the minimum local anesthetic dose (MLAD). Methods: Forty pregnant women undergoing elective cesarean section were allocated and randomized into two groups. The initial dose was 13mg for both ropivacaine and bupivacaine groups and was increased or decreased of 0.3mg, using the up-down sequential allocation technique. Efficacy was accepted if adequate sensory dermatomal anesthesia to pinprick to T6 was attained within 20 minutes after intrathecal injection and required no supplemental epidural injection for procedure until at least 50 minutes after the intrathecal injection of test drugs. The MLAD for both bupivacaine and ropivacaine was calculated with 95% confidence interval using the formula of Dixon and Massey. Comparison of different variables between the groups was done using t-test with significant p value at < 0.05. Results: The two groups were comparable in terms of demographic profile and clinical characteristics. The MLAD of ropivacaine and bupivacaine were 11.63 mg (95% CI, 11.5-12.92) and 10.459 mg (95% CI, 10.12-10.87) respectively. The potency ratio between spinal ropivacaine and bupivacaine was 0.89. Conclusion: Ropivacaine provided clinically surgical anaesthesia of shorter duration without compromising neonatal outcome and can be used as a safe alternative to bupivacaine.

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The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

Cited by 11 publications

References 30 publications

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

ED50 and ED95 of intrathecal hyperbaric ropivacaine for parturients undergoing cesarean section with prophylactic infusion of phenylephrine

Minimal Local Analgesic Dose of Intrathecal Bupivacaine and Ropivacaine in Patients Undergoing Cesarean Section: A Comparative Study

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