The median effective dose of spinal ropivacaine in combined spinal and epidural anesthesia for emergency cesarean section following failed vaginal delivery with epidural labor analgesia

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All data of the study. Including the primary outcome: the spinal dose of ropivacaine required to ensure a VAS score of ≤ 3 before delivery in 50% of the patients, with its 95% confidence interval (95% CI). The secondary outcomes included both maternal and neonatal observations. More specifically, maternal observations included the indications for EmCS, induction-to-delivery interval, duration of surgery, epidural rescue volume required in cases where satisfactory analgesia was not achieved, sensory level at the beginning of the cesarean section, the occurrence of a high-level block, administration of IV ephedrine for rescue during hypotension, the incidence of nausea and vomiting, maternal bradycardia, and total IV fluids administered before delivery during EmCS. Neonatal observations included the neonatal weight, Apgar scores at 1 and 5 min postdelivery, and pH and base excess (BE) values in the UA blood gas analysis. Other maternal characteristics were also recorded such as the age, weight, height, gestational week, gravidity, parity, duration of administration and drug volume required for analgesia during labor, sensory level before anesthesia, and indications for EmCS.

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