Low-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomised trial

Abstract 

Background

It is well known that intrathecal opioids have a synergic effect with spinal local anaesthetics. The aim of this study was to evaluate whether low-dose ropivacaine in combination with sufentanil could produce effective spinal anaesthesia with less maternal hypotension and vomiting than ropivacaine alone.

Methods

80 ASA I and II parturients undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomly allocated to two groups. Group R15 received intrathecal hyperbaric ropivacaine 15 mg and group SR10 hyperbaric ropivacaine 10 mg with sufentanil 5μg. Characteristics, efficacy and side effects of spinal anaesthesia in each group were measured.

Results

There was no significant difference in the quality of intraoperative analgesia and muscle relaxation between groups. The incidence of hypotension was significantly higher (55% vs. 20%, P<0.005) and the need for ephedrine less in group R15 than in group SR10. In group SR10, the onset of motor block was delayed (2.9±1.1 vs. 4.6±2.5 min, P<0.005), the duration was shorter (65.9±15.1 vs. 125.4±26.4 min, P<0.005). The duration of effective analgesia was longer (260±32.5 vs. 143±22.1 min, P<0.005), the incidence of shivering (20% vs. 60%, P<0.005) and vomiting (5% vs. 30%, P<0.005) were lower in group SR10.

Conclusions

The combination of hyperbaric ropivacaine 10 mg with sufentanil 5 μg produced effective spinal anaesthesia for caesarean delivery with significantly less hypotension, vomiting and shivering, shorter duration of motor blockade and longer lasting analgesia than hyperbaric ropivacaine15 mg.

Keywords: Anaesthesia, Obstetric, Caesarean section, Anaesthetic techniques, Subarachnoid, Local anaesthetics, Ropivacaine, Analgesics opioid, Sufentanil