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Several studies have applied lumbar spinal anesthesia (SA) with isobaric/hyperbaric bupivacaine and opioids in elective laparoscopic cholecystectomy (LC), documenting a superiority of the methodic over general anesthesia (GA) in terms of perioperative pain, nausea, and vomiting, though with a notable incidence of intraoperative right shoulder pain, potentially responsible for conversion to GA. This case series presents an opioid-free scheme of segmental thoracic spinal anesthesia (STSA) with hypobaric ropivacaine, reporting its benefits mainly in terms of shoulder pain occurrence. Hypobaric STSA was performed in nine patients undergoing elective LC between May 1 and September 1, 2022. The level of the needle insertion was included between T8 and T9, via a median or a paramedian approach. Midazolam (0.03 mg/kg) and Ketamine (0.3 mg/kg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 5 mg and then isobaric ropivacaine at a dose of 10 mg. Patients were placed in anti-Trendelenburg position for the entire duration of surgery. LC was conducted through the standard 3 or 4 ports technique with pneumoperitoneum maintained at a pressure of 8-10 mmHg. Mean patient age was 75.7 (±17.5) years, with a mean ASA score and Charlson comorbidity index (CCI) of 2.7 (±0.7) and 4.9 (±2.7), respectively. STSA was completed without complications in all patients, with no need for conversion to GA. Mean operative time and SA duration were 37.5 (±8.7) and 145.2 (±21.8) min, respectively. Intraoperatively, no shoulder or abdominal pain and nausea were reported, with only four and two patients requiring vasopressor and sedative intravenous drugs, respectively. Postoperatively, overall mean VAS pain score and within the first 12 hafter surgery were 3 (±2) and 4 (±2), respectively. Median length of stay was 2 (range = 1-3) days. Hypobaric opioid-free STSA appears to be a promising approach for laparoscopic surgeries, with minimal to null occurrence of shoulder pain. Larger prospective studies are required to validate these findings.

ObjectiveThe spinal block was limited to the operative side during unilateral spinal anesthesia, which has less physiological interference and fewer complications for the patient. The optimal dose of ropivacaine for unilateral spinal anesthesia is still unclear. The aim of this trial was to investigate the ED50 and ED95 of hypobaric ropivacaine during unilateral spinal anesthesia in older patients undergoing hip arthroplasty.MethodsAll patients were administered hypobaric ropivacaine at a spinal anesthetic drug concentration of 0.4%. The trial was conducted using the Dixon sequential method with an initial dose of 10 mg of ropivacaine and a dose difference of 0.5 mg between two consecutive patients. If the subject’s post-block non-surgical leg Bromage score is greater than 0, the next subject’s dose of ropivacaine is reduced by 0.5 mg. If the subject’s post-block non-surgical leg Bromage score is equal to 0, the next patient’s dose of ropivacaine is increased by 0.5 mg. The trial was terminated when alternating positive–negative results were obtained for 7 pairs of patients. ED50, ED95, and the corresponding 95% confidence intervals (CI) for unilateral spinal anesthesia with 0.4% hypobaric ropivacaine were calculated using probit regression analysis. Patients with motor block in the non-surgical leg were identified as the positive group, and patients without motor block in the non-surgical leg were identified as the negative group. Anesthesia onset time, sensory block duration, duration of motor block, the highest dermatomes blocked on the surgical side, and postoperative complications were compared between the two groups.ResultsThe ED50 and ED95 of hypobaric ropivacaine during unilateral spinal anesthesia in older patients undergoing hip arthroplasty were 11.13 mg (95% CI: 10.85–11.42 mg) and 10.30 mg (95% CI: 9.04–10.65 mg), respectively. The drug dosage was higher in the positive group than in the negative group. There was no differences in the onset of anesthesia, block plane of the affected side, the sensory and motor block time of affected side, and the incidences of low blood pressure, nausea and vomiting, chills, urinary retention between groups ( p > 0.05).ConclusionThe ED50 and ED95 of hypobaric ropivacaine during unilateral spinal anesthesia in older patients undergoing hip arthroplasty were 11.13 mg (95% CI: 10.85–11.42 mg) and 10.30 mg (95% CI: 9.04–10.65 mg), respectively. Unilateral spinal anesthesia limits the level of block to the operative side with less physiologically disruptive to the patient, more stable perioperative hemodynamics and fewer complications.

Background Subarachnoid anesthesia is the primary anesthetic method for elective cesarean section surgery, characterized by rapidly taking effect and reliable analgesia. However, subarachnoid anesthesia is prone to cause a high block level, resulting in a high incidence of maternal hypotension. How to reduce the incidence of maternal hypotension under subarachnoid anesthesia is a practical problem that needs to be solved urgently in clinical practice. Methods This prospective cohort study was performed at Nantong Maternal and Child Health Care Hospital in China between January and July 2023. This study compared the incidence of hypotension in pregnant women undergoing subarachnoid anesthesia during elective cesarean section in four groups, including group A (control group) with 10 mg of 10% glucose solution; Group B with 5 mg 10% glucose solution group; Group C with 4 mg 10% glucose solution group; Group D with 2 mg 10% glucose solution group. Each group was given a dose of 10 mg Ropivacaine with a concentration of 0.5% and a volume of 2 ml. The primary outcome was the incidence of maternal hypotension. The secondary outcomes were the plane of anesthesia, abdominal wall muscle relaxation degree and the incidence of adverse events. Results Data from 74 (18, A group; 26, B group; 15, C group; 15, D group) participants were analyzed. Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women ( P  = 0.152). The plane of anesthesia gradually shifted from T4 to T10 as the specific gravity of ropivacaine decreased ( P  < 0.01). Satisfaction about abdominal wall muscle relaxation degree gradually decreased with the decrease of the specific gravity of ropivacaine ( P  = 0.04). And the incidence of adverse events gradually increased with the decrease of the specific gravity of ropivacaine ( P  = 0.027). Conclusions Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women.