Huang Xiao-Dong, Qiu Xiao-Xiao, Wang He-Jie, Jin Xia-Fang, Xiao Fei
Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou Maternity and Child Healthcare Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Anesthesiology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China.
Front Pharmacol. 2024 Feb 16;15:1348700. doi: 10.3389/fphar.2024.1348700. eCollection 2024.
Previous studies have explored the median effective concentration (EC50) of ropivacaine for labor epidural analgesia in parturients with obesity. However, the clinical relevance of the 90% effective concentration (EC90) remains unclear. This study aimed to determine and compare the dose-response curve of epidural ropivacaine for labor analgesia between parturients with and without obesity. Parturients were divided into two groups based on body mass index (BMI): group N, consisting of parturients with BMI <30 kg/m, and group O, consisting of parturients with BMI >30 kg/m. Within each group, the patients were randomized to receive one of five concentrations (0.0375%, 0.075%, 0.1125%, 0.15%, or 0.1875%) of epidural ropivacaine for labor analgesia. Analgesia was induced with a loading dose of 15 mL of the assigned concentration. Visual analogue scale (VAS) scores were recorded at baseline and 30 min post-dose to calculate the response (%) using the formula [(baseline VAS pain score-VAS pain score at 30 min)/baseline VAS pain score] ×100%. The EC50 and EC90 values were determined via nonlinear regression analysis. The EC50 and EC90 values of ropivacaine were 0.061% (95% confidence interval [CI], 0.056%-0.066%) and 0.177% (95% CI, 0.152%-0.206%) in group N and 0.056% (95% CI, 0.051%-0.061%) and 0.161% (95% CI, 0.138%-0.187%) in group O, respectively. No significant differences were observed in the EC50 and EC90 values between the two groups (-values = 0.121 and 0.351, respectively. In conclusion, within the parameters of this study, our findings suggest that obesity, characterized by a mean BMI value of 30.9, does not significantly influence the EC50 and EC90 values of epidural ropivacaine for labor analgesia. Further investigations are warranted to elucidate the dose-response relationship between ropivacaine and obesity with higher BMI values. https://www.chictr.org.cn/showproj.html?proj=190747, Identifier ChiCTR2300073273.
既往研究已探讨了罗哌卡因用于肥胖产妇分娩硬膜外镇痛的半数有效浓度（EC50）。然而，90%有效浓度（EC90）的临床相关性仍不明确。本研究旨在确定并比较肥胖与非肥胖产妇硬膜外注射罗哌卡因用于分娩镇痛的剂量-反应曲线。根据体重指数（BMI）将产妇分为两组：N组，由BMI<30kg/m²的产妇组成；O组，由BMI>30kg/m²的产妇组成。在每组中，患者被随机分配接受五种浓度（0.0375%、0.075%、0.1125%、0.15%或0.1875%）之一的硬膜外罗哌卡因用于分娩镇痛。采用15mL指定浓度的负荷剂量诱导镇痛。在基线和给药后30分钟记录视觉模拟量表（VAS）评分，使用公式[（基线VAS疼痛评分-30分钟时VAS疼痛评分）/基线VAS疼痛评分]×100%计算反应率（%）。通过非线性回归分析确定EC50和EC90值。N组罗哌卡因的EC50和EC90值分别为0.061%（95%置信区间[CI]，0.056%-0.066%）和0.177%（95%CI，0.152%-0.206%），O组分别为0.056%（95%CI，0.051%-0.061%）和0.161%（95%CI，0.138%-0.187%）。两组之间的EC50和EC90值未观察到显著差异（P值分别为0.121和0.351）。总之，在本研究的参数范围内，我们的研究结果表明，以平均BMI值30.9为特征的肥胖并未显著影响硬膜外罗哌卡因用于分娩镇痛的EC50和EC90值。有必要进行进一步研究以阐明罗哌卡因与更高BMI值肥胖之间的剂量-反应关系。https://www.chictr.org.cn/showproj.html?proj=190747，标识符ChiCTR2300073273 。
