Esketamine administered epidurally as an adjuvant to epidural ropivacaine for labour analgesia: a prospective, double-blind dose-response study.

Autor: Xu L; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China., Li S; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China., Zhang C; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China., Zhou Y; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China., Chen X; Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China chenxinz@zju.edu.cn.
Jazyk: angličtina
Zdroj: BMJ open [BMJ Open] 2024 Nov 02; Vol. 14 (11), pp. e071818. Date of Electronic Publication: 2024 Nov 02.
DOI: 10.1136/bmjopen-2023-071818
Abstrakt: Objective: To investigate the efficacy of esketamine as an adjuvant to epidural ropivacaine for labour analgesia by determining its effect on the median effective concentration (EC 50 ) in a 20 ml volume of ropivacaine.
Design: A prospective, double-blind dose-response study.
Setting: This study was conducted in Women's Hospital, School of Medicine, Zhejiang University, China.
Participants: One hundred and fifty parturients who requested epidural analgesia were recruited in this study to randomly receive epidural ropivacaine alone or with esketamine of 0.2 mg ml -1 , 0.3 mg ml -1 , 0.4 mg ml -1 or 0.5 mg ml -1 , respectively.
Primary and Secondary Outcome Measures: The primary outcome, EC 50 of ropivacaine, was determined using an up-down sequential allocation technique. The secondary outcomes were analgesia characteristics, Ramsay Sedation Scale score, labour duration, caesarean section rate and adverse effects.
Results: The EC 50 of ropivacaine with the addition of esketamine at concentrations of 0.3 mg ml -1 , 0.4 mg ml -1 and 0.5 mg ml -1 resulted in significant reductions in the EC 50 of ropivacaine to 0.050%, 0.044% and 0.043%, respectively, from baseline (esketamine 0 mg ml -1 ) (p<0.0001). However, reductions of the EC 50 of ropivacaine were similar among the groups with esketamine of 0.3 mg ml -1 , 0.4 mg ml -1 and 0.5 mg ml -1 (p>0.05). The Ramsay Sedation Scale score was higher and more dizziness was observed in the Group of esketamine 0.5 mg ml -1 compared with all other groups (p<0.0001). During the peripartum period, no differences in sensory blockade level, Bromage score, labour duration and percentage of caesarean delivery were found among the groups.
Conclusions: Under the conditions of this study, the addition of epidural esketamine of 0.3 mg⋅mL -1 , 0.4 mg⋅mL -1 and 0.5 mg⋅mL -1 offered a similar ropivacaine dose-sparing effect; 0.5 mg⋅mL -1 of esketamine produced more adverse effects.
Trial Registration Number: ChiCTR2100054348.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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