Dose dependent reduction in median effective concentration (EC50) of ropivacaine with adjuvant dexmedetomidine in labor epidural analgesia: An up-down sequential allocation study - 16/12/20
Abstract |
Study objective |
Adjuvant dexmedetomidine can be used to reduce the required concentration of ropivacaine for labor epidural analgesia. However, the potency of dexmedetomidine has not been fully studied. The purpose of this study was to determine the median effective concentration (EC50) of ropivacaine with adjuvant dexmedetomidine.
Design |
Prospective, double-blind, up-down sequential allocation study.
Setting |
Academic medical center specializing in the care of women and children.
Patients |
One hundred and fifty healthy, term parturients requesting labor epidural analgesia were randomly assigned to 1 of 5 different concentrations of dexmedetomidine: 0 μg/ml, 0.3 μg/ml, 0.4 μg/ml, 0.5 μg/ml, or 0.6 μg/ml.
Interventions |
The study solution for the first patient in each group included the randomly assigned concentration of dexmedetomidine in 0.1% ropivacaine. Subsequent patients in each randomization group received the assigned concentration of dexmedetomidine in a new concentration of ropivacaine as determined by the up-down allocation methodology. Effective analgesia was defined as pain on the visual analogue scale of<3 at30 min after administration of local anesthetic. The up-down sequential allocation method and probit regression were used to calculate the EC50 of epidural ropivacaine.
Measurements |
The primary outcome was pain 30 min after administration of local anesthetic via epidural catheter. Exploratory outcomes included side effects, neonatal outcomes, and obstetric outcomes.
Main results |
The EC50 values for ropivacaine in dexmedetomidine 0.4 μg/ml, 0.5 μg/ml, and 0.6 μg/ml (0.044% [95% CI 0.036% to 0.045%], 0.035% [95% CI 0.031% to 0.041%], and 0.039% [95% CI 0.034% to 0.045%], respectively) were lower compared to ropivacaine in dexmedetomidine 0 μg/ml and 0.3 μg/ml (0.086% [95% CI 0.081% to 0.092%], and, 0.069% [95% CI 0.056% to 0.076%], respectively). Differences between EC50 values for ropivacaine in dexmedetomidine 0.4 μg/ml, 0.5 μg/ml, and 0.6 μg/ml were not statistically significant. Results of our exploratory analyses did not reveal differences in side effects, neonatal outcomes, or obstetric outcomes.
Conclusions |
In this study, the lowest concentration of dexmedetomidine in ropivacaine with the greatest clinical effect was 0.4 μg/ml, which is important because there may be no additional analgesic benefit of dexmedetomidine greater than 0.4 μg/ml.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Epidural dexmedetomidine can reduce ropivacaine requirements for labor analgesia. |
• | The optimum dose of epidural dexmedetomidine for labor analgesia is still unknown. |
• | Different dose of dexmedetomidine was compared the potency of reducing the EC50 of epidural ropivacaine. |
• | 0.4μg/ml dexmedetomidine was recommended as an optimum dose. |
Keywords : Dexmedetomidine, Labor analgesia, Epidural, Dose-response, 50% effective concentration
Abbreviations : ASA, BP, EC50, HR, VAS, SD, CI
Plan
Vol 68
Article 110115- février 2021 Retour au numéro
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