Comparison of ropivacaine plus sufentanil and ropivacaine plus dexmedetomidine for labor epidural analgesia: A randomized controlled trial protocol

The Influence of Dexmedetomidine as an Adjuvant in Intrathecal Labor Analgesia: A Multicenter Study on Efficacy and Maternal Satisfaction

In this study, we examined the impact of dexmedetomidine (DEX) on the effectiveness of epidural analgesia and labor outcomes. We administered different doses of DEX combined with 0.1% ropivacaine for epidural analgesia to evaluate the clinical effects and safety. To assess the effects of different concentrations of DEX in parturient women receiving epidural analgesia, we conducted a randomized double-blind trial. We selected 400 parturient women and randomly assigned them to 4 groups, with 100 parturient women in each group: S0.1 (0.1 µg/mL DEX), S0.2 (0.2 µg/mL DEX), S0.3 (0.3 µg/mL DEX), and a control group (0.3 µg/mL sufentanil). Post-analgesia, we recorded the Bromage score, duration of labor, method of delivery, bleeding, neonatal Apgar score, adverse reactions, and maternal satisfaction. The number of patients with a Bromage score of ≥2 and the incidence of bradycardia were higher in the S0.3 group compared with the other 3 groups (P < .05), whereas the high satisfaction rate was lower in the S0.3 group (P < .05). Moreover, we found that the number of times that additional patient-controlled analgesia was administered was higher in the S0.1 group compared with the remaining 3 groups (P < .05). The control group exhibited a higher incidence of pruritus than the other 3 groups (P < .05). In conclusion, when administering spinal anesthesia for the relief of labor pain, epidural analgesia with 0.1% ropivacaine combined with 0.2 µg/mL DEX provides relatively ideal analgesic effects, higher maternal satisfaction, and reduces the incidence of pruritus, compared with the combination of 0.1% ropivacaine and 0.3 µg/mL sufentanil.

Effect of OPRM1/COMT gene polymorphisms on sufentanil labor analgesia: a cohort study based on propensity score matching

Background: This study investigated the use of COMT G1947A and OPRM1 A118G polymorphisms as predictive markers for sufentanil epidural analgesia. Methods: The visual analogue scale (VAS) score, and sufentanil consumption of 136 pairs of parturients using sufentanil with lidocaine and ropivacaine for epidural analgesia were used for analysis. Results: OPRM1 AG/GG had lower VAS score difference between fifth and 0 min (1.55 vs 1.87; p = 0.012) and higher consumption (19.65 μg vs 17.11 μg; p = 0.049) than AA carriers. COMT GA/AA had higher VAS score difference than GG carriers (1.86 vs 1.55; p = 0.021). Conclusion: Sufentanil may provide better epidural labor analgesia in OPRM1 AA and COMT GA/AA carriers compared with OPRM1 AG/GG and COMT GG carriers. Clinical Trial Registration: ChiCTR1900026897 (Chinese Clinical Trial Center Registry).

Comparison of Efficacy and Safety of Different Doses of Dexmedetomidine for Epidural Labor Analgesia

Objective

To explore the efficacy and safety of different doses of dexmedetomidine (DEX) for epidural labor analgesia (ELA).

Methods

From June 2021 to June 2022, 147 parturients who underwent ELA in our hospital were selected and divided into low- (0.5 μg/kg DEX), medium- (0.75 μg/kg DEX), and high-dose (1.0 μg/kg DEX) groups (n = 49 for each) according to the random number table method. The analgesic effect was assessed using the Ramsay sedation score and Visual Analogue Scale (VAS), and the labor duration, mean arterial pressure (MAP), and heart rate (HR) before and after analgesia, vaginal bleeding within 2 h postpartum, and delivery outcomes (the cesarean section conversion rate and the neonatal Apgar score) were statistically analyzed. Furthermore, the incidence of adverse reactions was calculated, and maternal satisfaction with delivery was investigated.

Results

After analgesia, the the Ramsay and labor duration were higher in the high-dose group than those in the low- and medium-dose groups, and the VAS scores was lowerin the high-dose group than those in the low- and medium-dose groups(P < 0.05), while no difference was identified among the three groups in terms of the cesarean section conversion rate and the neonatal Apgar score (P > 0.05). The high-dose group had the greatest fluctuations in MAP and HR levels before and after analgesia than the other two groups, with a higher incidence of adverse reactions (P < 0.05). Finally, the survey of delivery satisfaction showed no significant difference in delivery satisfaction among the three groups (P > 0.05).

Conclusion

DEX has excellent performance in ELA, which can effectively relieve the pain of puerperae and shorten the labor process. Among them, low-dose DEX has higher safety and is recommended as the first choice. Trial Registrations. This trial is registered with ML2021073.

Application Analysis of Multiacupoint Stimulation in Multimodal Labor Analgesia during the Whole Stage of Labor in Primipara

Purpose

To analyze the application value of multimodal analgesia (MMA) regimen of patient-controlled epidural analgesia (PCEA) combined with multiacupoint stimulation analgesia during the whole stage of labor analgesia in primipara.

Methods

300 primiparas with natural delivery were selected. According to the different ways of labor analgesia, they were divided into the first stage of labor active period PCEA group (group A), the whole stage of labor PCEA group (group W), and the whole stage of labor PCEA combined with multiacupoint stimulation analgesia group (group WM). The effect of MMA during the whole-labor process on maternal and infant safety was evaluated. The specific observation indicators were as follows: visual analogue scale (VAS) scores before analgesia (T ₀), at full opening of the uterus (T ₁), at the end of the second stage of labor (T ₂), and at the end of the third stage of labor (T ₃); stress response indicators at T ₀ and T ₁: epinephrine (E), norepinephrine (NE), glucose (Glu), and β-endorphin (β-EP) levels; delivery time of each stage of labor; the Apgar score of newborns at 1 and 5 min after birth; indicators of umbilical artery blood gas analysis immediately after delivery: PH value, base excess (BE), partial pressure of oxygen (PaO₂), and partial pressure of carbon dioxide (PaCO₂); incidence of postpartum depression (PPD) at 6 weeks after delivery.

Results

At T ₁, T ₂, and T ₃, the VAS scores were lower in groups W and WM than in group A, and the VAS scores were lower in group WM than in group W (P < 0.05). At T ₀, there was no significant difference in the comparison of E, NE, Glu, and β-EP levels among the three groups (P > 0.05). At T ₁, the levels of E, NE, Glu, and β-EP were higher in the three groups than in the same group at T ₀, the levels of E, NE, and Glu were lower, the levels of β-EP were higher in groups W and WM than in group A, and the levels of β-EP were higher in group WM than in group W (P < 0.05). Comparing the delivery time of the first stage of labor in the three groups, groups A and WM were shorter than group W (P < 0.05). Comparing the delivery time of the second and third stages of labor in the three groups, there was no significant difference (P > 0.05). Comparing the Apgar scores of the three groups of newborns at 1 and 5 min after birth, there was no significant difference (P > 0.05). Comparing the incidence of newborn asphyxia in the three groups, there was also no significant difference (P > 0.05). Comparing the PH, BE, PaO₂, and PaCO₂ of three groups of newborns after delivery, there were no significant differences (P > 0.05). At 6 weeks after delivery, the incidence of PPD was lower in groups W (10.00%) and WM (8.00%) than in group A (20.00%) (P < 0.05).

Conclusion

The application of the MMA regimen of PCEA combined with multiacupoint stimulation for labor analgesia during the whole stage of labor in primipara can effectively reduce labor pain and stress response during the whole stage of labor and shorten the delivery time of the first stage of labor, the indicators of newborn Apgar score and umbilical artery blood gas analysis are not affected, and the incidence of PPD in patients is reduced, which can play a protective role for the safety of mother and infant.

Analgesic Effects of Dexmedetomidine Combined with Spinal and Epidural Anesthesia Nursing on Prostate Hyperplasia Patients after Transurethral Resection of Prostate by Intelligent Algorithm-Based Magnetic Resonance Imaging

To analyze the investigation of the application effects of different doses of dexmedetomidine (Dex) with combined spinal and epidural anesthesia nursing on analgesia after transurethral resection of prostate (TURP) by intelligent algorithm-based magnetic resonance imaging (MRI), MRI imaging segmentation model of mask regions with convolutional neural network (Mask R-CNN) features was proposed in the research. Besides, the segmentation effects of Mask R-CNN, U-net, and V-net algorithms were compared and analyzed. Meanwhile, a total of 184 patients receiving TURP were selected as the research objects, and they were divided into A, B, C, and D groups based on random number table method, each group including 46 cases. Patients in each group were offered different doses of Dex, and visual analogue scale (VAS) and Ramsay scores of different follow-up visit time, use of other analgesics, the incidence of postoperative cystospasm, and nursing satisfaction of patients in four groups were compared. The results demonstrated that Dice similarity coefficient (DSC) value, specificity, and positive predictive value of Mask R-CNN algorithm were $0.623\pm 0.084$ , 98.61%, and 69.57%, respectively, all of which were higher than those of U-net and V-net algorithms. Pain VAS scores and the incidence of cystospasm at different time periods of groups B and C were both significantly lower than those of group D ( $P<0.05$ ). Ramsay scores of groups B and C at 8 hours, 12 hours, 24 hours, and 48 hours after the operation were all remarkably higher than those in group D ( $P<0.05$ ). Besides, nursing satisfaction of groups B and C was obviously superior to that in group D, and the difference demonstrated statistical meaning ( $P<0.05$ ). The differences revealed that Dex showed excellent analgesic and sedative effects and could effectively reduce the incidence of complications after TURP, including cystospasm and nausea. In addition, it helped improve nursing satisfaction and patient prognosis.

Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction

BACKGROUND

Lower extremity fractures are mainly treated by surgical reduction, but this operation is often affected by the patient’s level of agitation and the type of anesthesia used. The main treatment for lower-extremity fractures is operative reduction. However, operations can often be affected by both agitation and the degree of anesthesia. Therefore, it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.

AIM

To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.

METHODS

A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group (n = 60) and a control group (n = 60) according to the anesthesia scheme; the control group received ultrasound-guided nerve block; the observation group was treated with dextromethomidine on the basis of the control group, and the mean arterial pressure, heart rate (HR), and blood oxygen saturation were observed in the two groups.

RESULTS

The mean arterial pressure of T1, T2 and T3 in the observation group were 94.40 ± 7.10, 90.84 ± 7.21 and 91.03 ± 6.84 mmHg, significantly higher than that of the control group (P < 0.05). The observation group’s HR at T1 was 76.60 ± 7.52 times/min, significantly lower than that of the control group (P < 0.05); The observation group’s HR at T2 and T3 was 75.40 ± 8.03 times/min and 76.64 ± 7.11 times/min, significantly higher than that of the control group (P < 0.05). The observation group’s visual analog score at 2 h, 6 h and 12 h after operation was 3.55 ± 0.87, 2.84 ± 0.65 and 2.05 ± 0.40. the recovery time was 15.51 ± 4.21 min, significantly lower than that of the control group (P < 0.05). Six hours post-anesthesia, epinephrine and norepinephrine in the observation group were 81. 10 ± 21.19 pg/mL and 510. 20 ± 98.27 pg/mL, significantly lower than that of the control group (P < 0.05), and the mini-mental state exam score of the observation group was 25. 51 ± 1.15, significantly higher than that in the control group (P < 0.05).

CONCLUSION

Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.

Ropivacaine suppresses tumor biological characteristics of human hepatocellular carcinoma via inhibiting IGF-1R/PI3K/AKT/mTOR signaling axis

Ropivacaine, a common local anesthetic in the clinic, has anti-proliferative and pro-apoptotic effects in numerous cancers, however, the underlying regulatory mechanism of ropivacaine in hepatocellular carcinoma remains unclear. In the current study, human HepG2 cells were stimulated with different ropivacaine concentrations. Cell Counting Kit-8 assay, cell colony formation, and cell cycle were used to monitor cell viability. Cell apoptosis, migration, and invasion were determined by flow cytometry and transwell assays. Tumor xenograft experiments were performed to prove the anti-cancer effect of ropivacaine in vivo. A high dose of ropivacaine inhibited proliferation and promoted apoptosis of HepG2 cells in a dose-dependent manner. Ropivacaine challenge also arrested cells in the G2 phase, followed by a decline in the protein expression of cyclin D1 and cyclin-dependent kinase 2, and an increase in p27 levels in HepG2 cells. Additionally, different ropivacaine doses suppressed cell migration and invasion by upregulating E-cadherin expression and downregulating N-cadherin expression. Mechanically, ropivacaine challenge gradually restrained insulin-like growth factor-1 receptor (IGF-1 R) expression and the activities of phosphorylated-PI3K, AKT, and mTOR in HepG2 cells with increased ropivacaine doses. In the tumor xenograft experiment, ropivacaine was confirmed to inhibit tumor growth, accompanied by inhibition of the IGF-1 R/PI3K/AKT/mTOR signaling axis. In conclusion, ropivacaine suppressed tumor biological characteristics and promoted apoptosis, resulting in the suppression of hepatocellular carcinoma progression by targeting the IGF-1 R/PI3K/AKT/mTOR signaling pathway. It is possible that ropivacaine-mediated local anesthesia may be developed as a novel surgical adjuvant drug for treating hepatocellular carcinoma.

Effect of ropivacaine and sufentanil in epidural labor analgesia

OBJECTIVE

To investigate the application value of ropivacaine combined with sufentanil for epidural labor analgesia in painless labor.

METHODS

A total of 157 cases of pregnant female received painless labor in our hospital from January 2019 to December 2020 were randomly divided into observation group (n=81 cases) and control group (n=76 cases). The subjects in the observation group received 0.1% ropivacaine combined with sufentanil (0.25 μg/ml) 10 ml and added into the painless delivery pump, and the control group received 0.1% ropivacaine 10 ml into the painless delivery pump. The analgesic effect, lactation function, delivery outcomes and the labor course of the two groups were compared.

RESULTS

In the active stage of labor, the time of first labor process was shorter compared with the control group, those in the observation group were more active than the control group (P<0.05). The lactation initiation time of the observation group was shorter than that of the control group, and the effective rate of lactation was higher than that of the control group (P<0.05). The Visual analogue scale (VAS) score at 5 min, 30 min, 60 min, and 90 min after analgesia were improved in the observation group, the analgesic effect of ropivacaine combined with sufentanil for epidural labor analgesia was prior to ropivacaine alone. There were significant differences in the rates of conversion to cesarean section and usage rate of forceps between the two groups (P<0.05), while there had no significant differences in lateral episiotomy rate and Apgar scores at 1 and 5 min after birth between the two groups (P>0.05).

CONCLUSION

Ropivacaine combined with sufentanil for epidural labor analgesia in painless labor can effectively relieve labor pain, improve lactation function, active the first stage of labor, shorten the time of labor, reduce the incidence of cesarean section and ensure the safety of mother and infant.