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

Xu, Wenping; Xiao, Fei; Zhang, Yinfa; Li, Lin; Chang, Xiangyang

doi:10.1097/md.0000000000013727

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…There were no restrictions based on the type of neuraxial anaesthesia used. In addition, studies were excluded that utilised unclear methodology; administered neuraxial anaesthesia doses < ED95, as reported by Ginosar et al and Xu et al (ED95 doses reported as ≥ 11.2 mg intrathecal bupivacaine [12] or ≥ 15.2 mg ropivacaine [13]); or where a block height less than a T6 level was achieved when epidural anaesthesia was used [14]. If block height was not reported in a study using epidural anaesthesia, the study was excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Secondary aims were to estimate the prevalence of conversion of neuraxial to general anaesthesia and to compare the prevalence of inadequacy between different modes of anaesthesia. [12] or ≥ 15.2 mg ropivacaine [13]); or where a block height less than a T6 level was achieved when epidural anaesthesia was used [14]. If block height was not reported in a study using epidural anaesthesia, the study was excluded.…”

Section: Introductionmentioning

confidence: 99%

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Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review

et al. 2022

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Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intraoperative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; prevalence of conversion from neuraxial anaesthesia to general anaesthesia following inadequate neuraxial anaesthesia; and the effect of mode of anaesthesia. We searched studies reporting inadequate neuraxial anaesthesia that used ≥ ED95 doses (effective dose in 95% of the population) of neuraxial local anaesthetic agents. Our primary outcome was the prevalence of inadequate neuraxial anaesthesia, defined as the need to convert to general anaesthesia; the need to repeat or abandon a planned primary neuraxial technique following incision; unplanned administration of intra-operative analgesia (excluding sedatives); or unplanned epidural drug supplementation. Fifty-four randomised controlled trials were included (3497 patients). The overall prevalence of requirement for supplemental analgesia or anaesthesia was 14.6% (95%CI 13.3-15.9%); 510 out of 3497 patients. The prevalence of general anaesthesia conversion was 2 out of 3497 patients (0.06% (95%CI 0.0-0.2%)). Spinal/combined spinal-epidural anaesthesia was associated with a lower overall prevalence of inadequate neuraxial anaesthesia than epidural anaesthesia (10.2% (95%CI 9.0-11.4%), 278 out of 2732 patients vs. 30.3% (95%CI 26.5-34.5%), 232 out of 765 patients). Further studies are needed to identify risk factors, optimise detection and management strategies and to determine long-term effects of inadequate neuraxial anaesthesia.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review

et al. 2022

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“…It is prudent to monitor that the total dose of the injected AL does not exceed the recommended total dose to avoid local neurotoxicity, or anesthetic effects. If possible, it is recommended that another type of LA be injected in the second subarachnoid puncture [12][13][14][15].…”

Section: Alpha2 Agonistsmentioning

confidence: 99%

Impact of Local Anesthetics on Intrathecal Anesthesia

Estrada¹

2020

ASOAJ

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Of all regional techniques, subarachnoid block is the fastest, most predictable, and most reliable. It is a technique that has unique characteristics for use in ambulatory surgery: immediate initiation of anesthesia, predictable response according to the dose administered, and the possibility of adjusting the anesthetic duration by selecting the appropriate agent. Its main advantages are its easy realization, the quick establishment of the lock, its high effectiveness and reliability and its low toxicity. It is a simple technique to perform since anatomical references are usually easy to locate and the procedure is performed in a short time, even in obese patients. The quality of the blockage is especially evident in interventions of the lower extremities performed with tourniquet and in perineal surgery, thanks to its ability to achieve complete sacral anesthesia. It has low toxicity because the small doses of local anesthetic required eliminate the risk of systemic toxicity in case of inadvertent intravascular injection.

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

Cited by 4 publications

References 21 publications

Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review

Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review

Impact of Local Anesthetics on Intrathecal Anesthesia

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

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