Department of Anaesthesia, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang 310006, China.
Acta Anaesthesiol Scand. 2010 Mar;54(3):284-90. doi: 10.1111/j.1399-6576.2009.02051.x. Epub 2009 Jul 22.
The addition of opioid to local anaesthetics has become a well-accepted practice of spinal anaesthesia for caesarean delivery. Successful caesarean delivery anaesthesia has been reported with the use of a low dose of intrathecal hyperbaric ropivacaine coadministered with sufentanil. This prospective, double-blinded study determined the median effective dose (ED50) of intrathecal hyperbaric ropivacaine with and without sufentanil for caesarean delivery, to quantify the sparing effect of sufentanil on the ED50 of intrathecal hyperbaric ropivacaine.
Sixty-four parturients undergoing elective caesarean delivery with combined spinal-epidural anaesthesia were randomized into two groups: Group R (ropivacaine) and Group RS (ropivacaine plus sufentanil 5 microg). The initial dose of ropivacaine was 13 mg in Group R and 10 mg in Group RS. The effective dose was defined as a T(6) level attained within 10 min and no supplemental epidural anaesthetic required during surgery. Effective or ineffective responses determined, respectively, a 0.3 mg decrease or increase of the dose of ropivacaine for the next patient using an up-down sequential allocation.
The ED50 of intrathecal ropivacaine was 11.2 mg [confidence interval (CI) 95%: 11.0-11.6] in Group R vs. 8.1 mg (CI 95%: 7.8-8.3) in Group RS. Motor block was markedly more intense in Group R than in Group RS, and the incidence of shivering was lower in Group RS than in Group R. There were no differences in the onset time of sensory block or motor block, in the incidence of hypotension, nausea and vomiting.
Intrathecal sufentanil 5 microg produced a 28% reduction of ED50 of intrathecal hyperbaric ropivacaine for caesarean delivery.
在剖宫产术的椎管内麻醉中，加入阿片类药物已成为一种广泛接受的做法。有报道称，鞘内使用低剂量的布比卡因复合舒芬太尼可以成功进行剖宫产麻醉。本前瞻性、双盲研究旨在确定鞘内应用布比卡因的半数有效剂量（ED50），并评估舒芬太尼对布比卡因 ED50 的节省作用。
本研究纳入了 64 例行择期剖宫产的产妇，她们接受了腰硬联合麻醉。这些产妇被随机分为两组：R 组（布比卡因组）和 RS 组（布比卡因+舒芬太尼 5μg 组）。R 组的初始布比卡因剂量为 13mg，RS 组为 10mg。如果在 10 分钟内达到 T6 平面且术中无需补充硬膜外麻醉，则认为剂量有效。如果是有效反应，则下一个患者的布比卡因剂量减少 0.3mg；如果是无效反应，则增加 0.3mg，使用上下序贯分配法进行分配。
R 组的鞘内布比卡因 ED50 为 11.2mg[95%置信区间（CI）：11.0-11.6]，RS 组为 8.1mg（95%CI：7.8-8.3）。R 组的运动阻滞明显比 RS 组强，RS 组的寒战发生率也低于 R 组。两组感觉阻滞和运动阻滞的起效时间、低血压、恶心和呕吐的发生率无差异。
鞘内给予舒芬太尼 5μg 可使鞘内应用布比卡因的 ED50 降低 28%，用于剖宫产麻醉。
