Mei Zhong, Ngan Kee Warwick D, Sheng Zhi-Min, Hu Li-Juan, Wu Zhan-Huai, Lyu Chang-Cheng, Chen Xin-Zhong, Qian Xiao-Wei
Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Anesthesiology, Zhejiang Xiaoshan Hospital, Hangzhou, China.
Department of Anesthesiology, Sidra Medicine, Doha, Qatar.
J Clin Anesth. 2020 Dec;67:110068. doi: 10.1016/j.jclinane.2020.110068. Epub 2020 Sep 24.
It is controversial whether local anesthetic dose requirement for spinal anesthesia for cesarean delivery differs between patients with singleton and patients with multiple gestation pregnancies. The aim of this study was to determine and compare the ED and ED for hyperbaric ropivacaine used for spinal anesthesia for cesarean delivery in patients with singleton pregnancies versus patients with twin pregnancies.
Prospective, randomized, comparative dose-finding study.
Operating room, Women's Hospital, Zhejiang University School of Medicine.
100 patients with singleton pregnancies (Group S) and 100 patients with twin pregnancies (Group T) presenting for scheduled cesarean delivery under combined spinal-epidural anesthesia were enrolled in the study.
Patients in Group S or Group T were randomly allocated to receive 9.5, 11, 12.5, 14 or 15.5 mg of hyperbaric ropivacaine intrathecally. A dose was considered effective when it achieved a bilateral sensory block level at the T6 dermatome or above within 10 min after intrathecal injection, there was no numerical rating scale (NRS) pain score ≥ 3 intraoperatively, and there was no requirement for epidural supplementation at any time during anesthesia and operation. Values for ED and ED for ropivacaine were determined using probit regression. The difference in ropivacaine dose requirement between patients with singleton pregnancies and patients with twin pregnancies was assessed by calculating relative median potency.
Success rates for different intrathecal doses of ropivacaine, side effects and neonatal outcomes were recorded.
The estimated (95% confidence interval) values for ED and ED of intrathecal ropivacaine in patients with singleton pregnancies were 11.2 (10.2 to 12.0) mg and 15.7 (14.4 to 18.3) mg, respectively. The values for ED and ED in patients with twin pregnancies were 10.5 (9.5 to 11.3) mg and 14.8 mg (13.6 to 17.0) mg, respectively. The estimate of relative median potency for ropivacaine between patients with singleton and twin pregnancies was 0.94 (95% confidence interval 0.83 to 1.04).
Patients with singleton and twin pregnancies have similar dose requirement for hyperbaric ropivacaine used for spinal anesthesia for cesarean delivery in the setting of combined spinal-epidural (CSE) anesthesia, no opioids, low weight cohort, insertion with the patients in the right lateral position, and norepinephrine boluses.
单胎妊娠患者与多胎妊娠患者剖宫产脊髓麻醉的局部麻醉药剂量需求是否存在差异，这一问题存在争议。本研究的目的是确定并比较用于单胎妊娠患者与双胎妊娠患者剖宫产脊髓麻醉的高压罗哌卡因的半数有效剂量（ED）和95%有效剂量（ED）。
前瞻性、随机、比较剂量探索研究。
浙江大学医学院附属妇产科医院手术室。
本研究纳入了100名单胎妊娠患者（S组）和100名双胎妊娠患者（T组），她们均计划在腰麻-硬膜外联合麻醉下行剖宫产术。
S组或T组患者被随机分配接受鞘内注射9.5、11、12.5、14或15.5mg高压罗哌卡因。当鞘内注射后10分钟内双侧感觉阻滞平面达到T6皮节或以上，术中数字疼痛评分量表（NRS）疼痛评分≥3，且麻醉和手术期间任何时候均无需硬膜外补充时，该剂量被认为有效。使用概率回归确定罗哌卡因的ED和ED值。通过计算相对中位效能评估单胎妊娠患者与双胎妊娠患者罗哌卡因剂量需求的差异。
记录不同鞘内罗哌卡因剂量的成功率、副作用和新生儿结局。
单胎妊娠患者鞘内罗哌卡因的估计（95%置信区间）ED和ED值分别为11.2（10.2至12.0）mg和15.7（14.4至18.3）mg。双胎妊娠患者的ED和ED值分别为10.5（9.5至11.3）mg和14.8mg（13.6至17.0）mg。单胎妊娠与双胎妊娠患者罗哌卡因的相对中位效能估计值为0.94（95%置信区间0.83至1.04）。
在腰麻-硬膜外联合（CSE）麻醉、无阿片类药物、低体重队列、患者右侧卧位插入以及去甲肾上腺素推注的情况下，单胎妊娠和双胎妊娠患者剖宫产脊髓麻醉使用高压罗哌卡因的剂量需求相似。
Zotero 插件