EC50 of Epidural Ropivacaine Combined With Dexmedetomidine for Labor Analgesia

Wp, Zhang; Li, Cuiling

doi:10.1097/ajp.0000000000000613

Cited by 17 publications

(17 citation statements)

References 16 publications

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“…Epidural morphine has previously been indicated to not be associated with neonatal outcome (35). Previous studies have also suggested that epidural dexmedetomidine has no adverse effects on neonates (1,2,(9)(10)(11)(12). Similar results were obtained in the present study with co-administration of epidural dexmedetomidine and morphine.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic meta-analysis demonstrated that dexmedetomidine as an adjuvant in epidural anesthesia provided improved sedation and analgesia with a well-documented safety profile (7). Several studies involving epidural dexmedetomidine in obstetric populations have been published: Dexmedetomidine added to combined spinal (bupivacaine)-epidural (fentanyl) anesthesia for cesarean section (1,2); combined epidural dexmedetomidine and ropivacaine for post-cesarean analgesia (8); and epidural dexmedetomidine combined with ropivacaine or bupivacaine for labor analgesia (9)(10)(11)(12). All these previous studies demonstrated the potentiating effect of epidural dexmedetomidine on neuraxial analgesia, with minimal side effects (1,2,(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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“…35 We, therefore, injected 5 mL of 0.5% ropivacaine containing 0.3 μg/kg dexmedetomidine each from T4 to T8 in the PVB, which is considered safe according to a previous report. 36 Compared to the C group, patients in P group had lower VAS scores both at rest and with coughing during the first 24 h after surgery, indicating that PVB combined with parecoxib could provide effective postoperative pain control. Notably, both the time to first dose rescue ketorolac and total consumption of ketorolac were significantly lower in Notes: Variables presented as mean ± SD or number of patients n (%).…”

Section: Discussionmentioning

confidence: 85%

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Yang¹,

Hao²,

Li³

et al. 2020

JPR

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Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.

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“…9 L'utilisation clinique de la dexmédétomidine s'est toutefois répandue vers d'autres usages hors indications. En anesthésie obstétricale, cet agent est utilisé dans le cadre d'une analgésie intraveineuse multimodale pour le travail et post-césarienne, 10-13 en tant qu'adjuvant neuraxial dans l'espace péridural pour le travail, 14 et par voie intrathécale pour la prévention des frissons pendant un accouchement par césarienne. 15 Dans ce numéro du Journal, Lamontagne et coll.…”

Section: La Dexmédétomidine Pour Tous Les Accouchements Par Césariennunclassified

“…9 Nevertheless, the clinical use of dexmedetomidine has expanded to various off-label uses. In obstetrical anesthesia, it has been used as part of multi-modal intravenous labour and post-CD analgesia, 10-13 as a neuraxial adjunct in the epidural space for labour, 14 and intrathecally for shivering prevention during CD. 15 In this issue of the Journal, Lamontagne et al 2 present a novel use of this drug in parturients to treat shivering during CD.…”

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confidence: 99%

Dexmedetomidine for every Cesarean delivery…maybe not?

Bautista

George

2019

Can J Anesth/J Can Anesth

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EC50 of Epidural Ropivacaine Combined With Dexmedetomidine for Labor Analgesia

Abstract: The EC50 of epidural ropivacaine for labor analgesia was 0.083% (95% CI, 0.077%-0.089%) and decreased to 0.062% (95% CI, 0.058%-0.066%) when combined with 0.5 μg/mL dexmedetomidine (http://www.chictr.org.cn, registration number: ChiCTR-OPC-16008548).

Cited by 17 publications

References 16 publications

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Dexmedetomidine for every Cesarean delivery…maybe not?

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