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Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study
Clinical Interventions in Aging ( IF 3.6 ) Pub Date : 2022-08-11 , DOI: 10.2147/cia.s371219
Yu Wang 1 , Hanning Zha 1 , Xiang Fang 2 , Tianjiao Shen 1 , Kunyun Pan 1 , Jianping Zhang 1 , Keqiang He 1 , Sheng Wang 1 , Liguo Hu 1
Affiliation  

Objective: The dose selection of ropivacaine for spinal anesthesia in clinical work mainly depends on the experience of the anesthesiologist. In this study, a prospective and modified up-down sequential allocation design was used to provide the optimal dose selection of ropivacaine for spinal anesthesia.
Patients and methods: This study was divided into two stages, and a total of 164 elderly patients with elective hip fractures were included. In stage I, the dose of ropivacaine was selected using the up-down sequential method of height correction, and the 50% effective dose (ED50) and 95% effective dose (ED95) were obtained. A nomogram for predicting satisfactory anesthesia and a formula for predicting the optimal dose was also given in this stage. In stage II, the dose of ropivacaine was calculated by using the optimal dose prediction formula, so as to evaluate the efficacy and safety of the model.
Results: The ED50 and ED95 of the stage I were 7.036 mg (95%CI 6.549– 7.585 mg) and 8.709 mg (95%CI 7.902– 14.275 mg), respectively. And provided a nomogram predicting satisfactory anesthesia with a C-index of 0.847 (95%CI 0.774– 0.92). The optimal dose prediction formula of ropivacaine was calculated, including variables for age, gender, height, and weight. This formula was found to be 90% efficient. It is worth mentioning that the incidence of direct transfer to the ward in the two stages was as high as 86.84% and 93.33%, respectively, and no patients were transferred to the ICU in stage II.
Conclusion: The ED50 and ED95 of ropivacaine were 7.036 mg and 8.709 mg, respectively, and the nomograms are sufficiently accurate to predict satisfactory anesthesia. Beyond that, the dose prediction equation provided in this study has high efficacy and safety, and can guide the dose selection of spinal anesthesia in elderly patients with hip fracture in clinical practice.
Clinical trials registration: ChiCTR2100046982

Keywords: ropivacaine, dose selection, elder, spinal anesthesia, Hip fracture, sequential design


中文翻译:

罗哌卡因用于老年髋部骨折患者脊髓麻醉的剂量选择:一项自上而下的顺序分配研究

目的:临床工作中罗哌卡因腰麻的剂量选择主要取决于麻醉医师的经验。在这项研究中,采用前瞻性和改进的上下顺序分配设计来提供罗哌卡因用于脊髓麻醉的最佳剂量选择。
患者和方法:本研究分为两个阶段,共纳入164例择期髋部骨折老年患者。I期罗哌卡因剂量选择采用上下序贯高度校正法,分别得到50%有效剂量(ED50)和95%有效剂量(ED95)。该阶段还给出了预测满意麻醉的列线图和预测最佳剂量的公式。在Ⅱ期,采用最佳剂量预测公式计算罗哌卡因的剂量,以评价模型的有效性和安全性。
结果:I 期的 ED50 和 ED95 分别为 7.036 mg(95%CI 6.549–7.585 mg)和 8.709 mg(95%CI 7.902–14.275 mg)。并提供了一个预测满意麻醉的列线图,C 指数为 0.847 (95%CI 0.774–0.92)。计算了罗哌卡因的最佳剂量预测公式,包括年龄、性别、身高和体重等变量。发现该公式的效率为 90%。值得一提的是,两个阶段直接转病房的发生率分别高达86.84%和93.33%,II期没有病人转入ICU。
结论:罗哌卡因的 ED50 和 ED95 分别为 7.036 mg 和 8.709 mg,列线图足以准确预测令人满意的麻醉。除此之外,本研究提供的剂量预测方程具有较高的有效性和安全性,可以指导临床实践中老年髋部骨折患者腰麻的剂量选择。
临床试验注册: ChiCTR2100046982

关键词:罗哌卡因,剂量选择,老年人,腰麻,髋部骨折,序贯设计
更新日期:2022-08-11
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