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已发表论文
罗哌卡因硬脊膜穿刺硬膜外给药与标准硬膜外给药技术用于分娩镇痛的起效比较：一项前瞻性随机剂量分配研究
Authors Xiao F , Drzymalski DM, Dong YF, Huang JY, Gao Y, Yan HY , Hu HJ
Received 18 June 2025
Accepted for publication 13 September 2025
Published 25 September 2025 Volume 2025:19 Pages 8745—8753
DOI https://doi.org/10.2147/DDDT.S547879
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Tin Wui Wong
Fei Xiao,1,2 Dan M Drzymalski,3 Yu-Fang Dong,2 Jia-Yue Huang,2 Yan Gao,2 Hai-Ya Yan,1 Hui-Jing Hu2
1Department of Anesthesiology, The Affiliated Women and Children’s Hospital of Ningbo University, Ningbo, People’s Republic of China; 2Department of Anesthesiology, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, People’s Republic of China; 3Tufts Medical Center, Department of Anesthesiology and Perioperative Medicine, Boston, MA, USA
Correspondence: Hui-Jing Hu, Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, East Zhonghuang Road, 2468#, Jiaxing, People’s Republic of China, Email hhj08mz@163.com
Background: When compared to the standard epidural technique, the dural puncture epidural (DPE) technique is reported to provide quicker onset of labor analgesia and improved quality of analgesia. Recently, the DPE technique was found to lower the effective dose for 90% (ED90) of patients receiving bupivacaine for labor analgesia by 35%. However, key pharmacological differences between bupivacaine and ropivacaine and the effect of a DPE technique on ropivacaine doses have not been studied. Therefore, we aimed to determine the effective dose for 50% (ED50) and ED90 of ropivacaine for labor analgesia in parturients when initiated with the DPE and standard epidural techniques.
Methods: Study participants were randomized to receive one of the five doses of ropivacaine (12, 15, 18, 21, and 24 mg) undergoing one of the two epidural techniques (either a DPE or standard epidural technique). A total volume of 20 mL of local anesthetic was administered epidurally. Effective analgesia was defined as the patient reporting an NRS pain score < 3 at 20 minutes following drug administration. The ED50 and ED90 values of epidural ropivacaine for labor analgesia were determined using probit analysis, and comparisons were made using the relative median potency ratio.
Results: The ED50 of ropivacaine for initiating labor analgesia using the DPE vs standard epidural techniques was 18.6 mg (95% CI, 16.4 to 21.1 mg) vs 19.2 mg (95% CI, 17.0 to 21.8 mg), respectively. The ED90 values were 30.5 mg (95% CI, 26.6 to 38.3 mg) vs 31.1 mg (95% CI, 27.1 to 39.2 mg), respectively. The relative median potency ratio for ropivacaine with DPE vs standard epidural technique was − 0.6 (95% CI, − 4.0 to 2.6).
Conclusion: Our findings suggest that there is no dose-sparing effect of ropivacaine when using the DPE technique vs a standard epidural technique for labor analgesia.
Keywords: labor analgesia, dural puncture epidural, standard epidural, ropivacaine, dose–response
1Department of Anesthesiology, The Affiliated Women and Children’s Hospital of Ningbo University, Ningbo, People’s Republic of China; 2Department of Anesthesiology, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, People’s Republic of China; 3Tufts Medical Center, Department of Anesthesiology and Perioperative Medicine, Boston, MA, USA
Correspondence: Hui-Jing Hu, Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, East Zhonghuang Road, 2468#, Jiaxing, People’s Republic of China, Email hhj08mz@163.com
Background: When compared to the standard epidural technique, the dural puncture epidural (DPE) technique is reported to provide quicker onset of labor analgesia and improved quality of analgesia. Recently, the DPE technique was found to lower the effective dose for 90% (ED90) of patients receiving bupivacaine for labor analgesia by 35%. However, key pharmacological differences between bupivacaine and ropivacaine and the effect of a DPE technique on ropivacaine doses have not been studied. Therefore, we aimed to determine the effective dose for 50% (ED50) and ED90 of ropivacaine for labor analgesia in parturients when initiated with the DPE and standard epidural techniques.
Methods: Study participants were randomized to receive one of the five doses of ropivacaine (12, 15, 18, 21, and 24 mg) undergoing one of the two epidural techniques (either a DPE or standard epidural technique). A total volume of 20 mL of local anesthetic was administered epidurally. Effective analgesia was defined as the patient reporting an NRS pain score < 3 at 20 minutes following drug administration. The ED50 and ED90 values of epidural ropivacaine for labor analgesia were determined using probit analysis, and comparisons were made using the relative median potency ratio.
Results: The ED50 of ropivacaine for initiating labor analgesia using the DPE vs standard epidural techniques was 18.6 mg (95% CI, 16.4 to 21.1 mg) vs 19.2 mg (95% CI, 17.0 to 21.8 mg), respectively. The ED90 values were 30.5 mg (95% CI, 26.6 to 38.3 mg) vs 31.1 mg (95% CI, 27.1 to 39.2 mg), respectively. The relative median potency ratio for ropivacaine with DPE vs standard epidural technique was − 0.6 (95% CI, − 4.0 to 2.6).
Conclusion: Our findings suggest that there is no dose-sparing effect of ropivacaine when using the DPE technique vs a standard epidural technique for labor analgesia.
Keywords: labor analgesia, dural puncture epidural, standard epidural, ropivacaine, dose–response