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A Dose-finding Study: Spinal Ropivacaine for Cesarean Section in a Large Randomized Asian Population
Abstract Number: S5B-2
Abstract Type: Original Research
Background: Earlier studies demonstrated that the intrathecal ropivacaine could be used to provide quality anesthesia with advantages of lesser hypotension and quick recovery compared to bupivacaine for cesarean delivery. However, the optimal dose of spinal ropivacaine in obstetric patients varies greatly in different reports1,2. Here we designed a randomized double-blind study to determine the optimal dose of spinal ropivacaine for elective cesarean delivery.
Methods: After approval from institutional ethics committee of Nanjing Maternity and Child Health Hospital in China and obtaining informed consent, a prospective randomized double blind study was conducted on 500 healthy primiparas pregnant women undergoing elective cesarean delivery. Double blinding was achieved by – an anesthesiologist who was not involved in subsequent evaluation prepared the drug. Both anesthesiologist assessing the patient and the study subjects were blinded for the group assignment. Patients were randomized into 5 groups to receive: 10mg (R10), 12mg (R12), 14mg (R14), 16mg (R16) or 18mg (R18) hyperbaric spinal ropivacaine (AstraZeneca, UK, 0.75% ropivacaine diluted to 3ml with NS containing 10% dextrose). Speed of onset, duration of sensory and motor block, patients’ satisfaction, surgeons’ satisfaction, supplement of IV analgesics, incidence of hypotension and nauseas/vomiting were compared. p<0.05 was considered significant.
Results: 492 patients completed study. All the parturients in our study were comparable with respect to age, weight and height. The average duration of cesarean section was 40 minutes. Mean time to achieve T6 sensory block was significant shorter in R18 compared to R10 (Mean ±SD 2±0.8 min vs. 3.05±1.2 min, p<0.05). Accordingly, the duration of sensory block (regression to T12) was markedly longer in R18 than R10 (151.3±30.7 min vs. 92.3±30.5 min, p<0.05). Importantly, the perfect patients’ satisfaction was much higher in R18 than R10 (100% vs. 66%, p<0.05), same as surgeons’ satisfaction (100% vs. 49%, p<0.05). In consideration of satisfactory analgesia and side effects, R14 was the optimal dose with comparable patients’ satisfaction (99% vs. 100%), surgeons’ satisfaction (95% vs. 100%) and much lower incidence of hypotension (17% vs. 32%, p<0.05) compared to R18.
Conclusion: 14mg of hyperbaric ropivacaine provides reliable and effective quality of spinal anesthesia for cesarean section with fewer side effects.
References: 1. Anesthesiology 2001; 95:1346-1250
2. Chinese Medical J 2015;128:2577-2582