Trial reportBMC pregnancy and childbirth2021
Optimum dose of spinal ropivacaine with or without single intravenous bolus of S-ketamine during elective cesarean delivery: a randomized, double-blind, sequential dose-finding study.
Trial report in BMC pregnancy and childbirth, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Efficacy and safety of esketamine on major depression, postpartum depression and perioperative depression: a systematic review and meta-analysis.Molecular psychiatry · 2026Pooled it
- Perioperative use of esketamine for the prevention of postpartum depression after cesarean section: a meta-analysis.BMC pregnancy and childbirth · 2025Pooled it
- Efficacy and safety of ketamine and esketamine in reducing the incidence of postpartum depression: an updated systematic review and meta-analysis.BMC pregnancy and childbirth · 2025Pooled it
- Determining the 90% Effective Dose of Remimazolam to Prevent Physical Movement in Surgical Abortions: A Biased-Coin Up-and-Down Sequential Allocation Trial.Drug design, development and therapy · 2025Trial
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- Esketamine Combined with Dexmedetomidine to reduce Visceral Pain During elective Cesarean Section Under Combined Spinal-Epidural Anesthesia: A double-Blind Randomized Controlled Study.Drug design, development and therapy · 2024Trial
- Comparison Between Esketamine and Alfentanil for Hysteroscopy: A Prospective, Double-Blind, Randomized Controlled Trial.Drug design, development and therapy · 2024Trial
- Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery: A Randomized Clinical Trial.JAMA network open · 2023Trial
- Comparative Efficacy of Interventions for the Prevention and Treatment of Postpartum Depression: A Bayesian Network Meta-analysis.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2026Review
- Clinical applications of esketamine: Current status and future perspectives.The Journal of international medical research · 2026Review
- A Study on the ED90 of Esketamine Combined with Ropivacaine for Early Epidural Analgesia During the First Stage of Labor in Nulliparous Women: A Randomized, Sequential Dose-Finding Trial.International journal of women's health · 2026Article
- Esketamine alleviated cardiomyocyte ferroptosis induced by oxygen-glucose deprivation/reoxygenation (OGD/R) via cyclic GMP-AMP synthase interactor.Cytotechnology · 2025Article
- Effect of esketamine on reducing postpartum pain and depression.World journal of clinical cases · 2025Article
- Heavy gravity combined with light gravity local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in maternal women: a prospective cohort study.BMC anesthesiology · 2025Article
- The impact of esketamine combined with butorphanol on postoperative analgesia and maternal psychological status after cesarean section: A randomized controlled study.Journal of anesthesia and translational medicine · 2024Article
- Median effective dose of spinal ropivacaine in combined spinal and epidural anesthesia for emergency cesarean delivery following failed vaginal delivery with epidural labor analgesia: a single-blind, sequential dose-finding study.Journal of anesthesia · 2024Article
- Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial.Anesthesiology and pain medicine · 2024Article
- Determining the optimum dose of remifentanil in combination with propofol for total intravenous anaesthesia in hysteroscopy under Narcotrend and SPI monitoring.Therapeutic advances in drug safety · 2024Article
- Neonatal outcomes when intravenous esketamine is added to the parturients transferred from labor analgesia to emergency cesarean section: a retrospective analysis report.BMC anesthesiology · 2023Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMaternal hypotension after spinal anaesthesia occurs at a high rate during caesarean delivery and can lead to adverse maternal or foetal outcomes. The aim of this study was to determine the optimal dose of spinal ropivacaine for caesarean section with or without intravenous single bolus of S-ketamine and to observe the rates of hypotension associated with both methods.
methodsEighty women undergoing elective caesarean delivery were randomly allocated into either a ropivacaine only or ropivacaine with intravenous S-ketamine group. If the upper sensory level of the patient reached T6 and the visual analogue scale (VAS) scores remained below 3 points before delivery, the next patient had a 1/9th chance of receiving a lower dose or an 8/9th chance of receiving the same dose as the previous patient. If the patient had VAS scores of more than 2 points or needed an extra epidural rescue bolus before delivery, a higher dose was used for the next patient. The primary outcome was the successful use of spinal ropivacaine to maintain patient VAS score of < 3 points before delivery and the incidence of post-spinal hypotension in both groups. Secondary outcomes included the rates of hypotension-related symptoms and interventions, upper sensory level of anaesthesia, level of sedation, neonatal outcomes, Edinburgh Postnatal Depression Scale scores at admission and discharge, and post-operative analgesic effect. The 90% effective dose (ED90) and 95% confidence interval (95% CI) were estimated by isotonic regression.
resultsThe estimated ED90 of ropivacaine was 11.8 mg (95% CI: 11.7-12.7) with and 14.7 mg (95% CI: 14.6-16.0) without intravenous S-ketamine, using biased coin up-down sequential dose-finding method. The rates of hypotension and associated symptoms were significantly lower in S-ketamine group than in the ropivacaine only group.
conclusionsA spinal dose of ropivacaine 12 mg with a single intravenous 0.15 mg/kg bolus dose of S-ketamine may significantly reduce the risk of hypotension and induce sedation before delivery. This method may be used with appropriate caution for women undergoing elective caesarean delivery and at a high risk of hypotension or experiencing extreme nervousness.
trial registrationhttp://www.chictr.org.cn ( ChiCTR2000040375 ; 28/11/2020).
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