Li Min, Xie Guohao, Chu Lihua, Li Yan
Department of Anesthesiology, The First Hospital of Fuyang, Hangzhou, China.
Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Matern Fetal Neonatal Med. 2025 Dec;38(1):2519655. doi: 10.1080/14767058.2025.2519655. Epub 2025 Jun 19.
Many studies have compared the anesthetic effects of different doses of hypobaric local anesthetics (without glucose) in spinal anesthesia for cesarean sections. Therefore, a meta-analysis of these trials is warranted.
Systematic review and meta-analysis of eligible randomized controlled trials comparing the efficacy of low-dose spinal hypobaric anesthetics (Bupivacaine < 10 mg, levobupivacaine < 10 mg, ropivacaine < 15 mg) with conventional dose (Bupivacaine/Levobupivacaine ≥ 10 mg, ropivacaine ≥ 15 mg) in elective and subemergency Cesarean sections in data sources PubMed, Embase, Web of Science, and Cochrane Central) from inception to February 2025.
We obtained data from 1,280 patients from 17 published trials. Low-dose hypobaric local anesthetics reduce hypotension occurrence (risk ratio [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; low evidence grade) but comprise anesthesia effect (analgesic-supplementation risk: RR 3.13, 95%CI 2.14 to 5.59, moderate evidence grade). In the subgroup analysis (based on whether opioid adjuvants mixed with local anesthetics were equal), there were no differences in anesthetic effects between low-dose local anesthetics mixed with opioid adjuvants and conventional-dose local anesthetics without opioid adjuvants between the two groups (analgesic-supplementation risk: RR 1.32, 95%CI 0.58 to 3.00, moderate evidence grade). Other secondary outcomes, including hypotensive side effects (nausea/vomiting and bradycardia), ephedrine consumption, and highest block plane, were observed less or lower in the low-dose group. No significant differences were found in trembling, pruritus, time to maximum block, or neonatal outcomes between the two groups.
Low-dose hypobaric local anesthetics in spinal anesthesia may reduce maternal side effects (hypotension, nausea/vomiting, and bradycardia) but comprise anesthetic efficacy (analgesic-supplementation risk). Furthermore, intrathecal opioid adjuvants improve anesthetic efficacy.
The protocol for this systematic review was registered on PROSPERO (CRD42024533150).
许多研究比较了不同剂量的低压局部麻醉药（不含葡萄糖）用于剖宫产脊髓麻醉的麻醉效果。因此，有必要对这些试验进行荟萃分析。
对符合条件的随机对照试验进行系统评价和荟萃分析，比较低剂量脊髓低压麻醉药（布比卡因<10mg，左旋布比卡因<10mg，罗哌卡因<15mg）与常规剂量（布比卡因/左旋布比卡因≥10mg，罗哌卡因≥15mg）在择期和亚急诊剖宫产中的疗效，数据来源为PubMed、Embase、Web of Science和Cochrane Central，检索时间从数据库建立至2025年2月。
我们从17项已发表试验的1280例患者中获取了数据。低剂量低压局部麻醉药可降低低血压的发生率（风险比[RR]，0.56；95%置信区间[CI]，0.43至0.73；低证据等级），但会影响麻醉效果（追加镇痛风险：RR 3.13，95%CI 2.14至5.59，中等证据等级）。在亚组分析中（基于与局部麻醉药混合的阿片类佐剂是否相等），两组中与阿片类佐剂混合的低剂量局部麻醉药与未使用阿片类佐剂的常规剂量局部麻醉药之间的麻醉效果无差异（追加镇痛风险：RR 1.32，95%CI 0.58至3.00，中等证据等级）。在低剂量组中，观察到其他次要结局，包括低血压副作用（恶心/呕吐和心动过缓）、麻黄碱用量和最高阻滞平面，出现的频率更低或程度更低。两组在颤抖、瘙痒、达到最大阻滞的时间或新生儿结局方面未发现显著差异。
脊髓麻醉中使用低剂量低压局部麻醉药可能会降低产妇的副作用（低血压、恶心/呕吐和心动过缓），但会影响麻醉效果（追加镇痛风险）。此外，鞘内注射阿片类佐剂可提高麻醉效果。
本系统评价方案已在PROSPERO（CRD42024533150）上注册。
