A clinical study on spinal anaesthesia with an equal dose and different concentrations of ropivacaine combined with epidural anaesthesia during caesarean section

Abstract

Background: Patients who undergo spinal anaesthesia combined with epidural block during caesarean section often have prolonged dyskinesia and leg numbness after the operation. This study explored whether small-dose and low-concentration local anaesthetics can meet the needs of surgery while helping relieve motor blocks earlier, reduce discomfort during leg numbness, and promote early maternal activity to provide additional options for women undergoing caesarean section. Methods: One hundred and twenty patients who underwent elective caesarean section were randomly divided into three groups according to the local anaesthetic concentration: 0.6%, 0.5%, and 0.4% ropivacaine. In all the groups, the puncture point, total dose and injection speed were the same, and an epidural catheter was inserted. Additionally, 2% lidocaine was added to the epidural catheter when the effect of spinal anaesthesia decreased during the operation. The primary outcome was the duration of lidocaine supplementation. Other secondary outcomes were the onset time, duration, highest sensory and motor block levels, use of additional epidural drugs, vital signs, adverse reactions, satisfaction and so on. Results: The sensory and motor block levels decreased faster and were shorter in the 0.4% ropivacaine group than in the other two groups, but additional epidural drugs were needed. Intraoperative circulation was more stable. There were no significant differences in adverse reactions or satisfaction among the groups. Conclusions: A small dose of 0.4% ropivacaine can meet the needs of surgery during combined spinal-epidural anaesthesia for caesarean section, and parturients can recover lower limb sensation and motor function faster after surgery; however, it is necessary to determine the operation time and administer epidural drugs in a timely manner. Trial registration: ChiCTR-2000030968 (Chictr.org.cn); registered on 20/03/2020.