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Relationship Between Body Mass Index and Spread of Spinal Anesthsia in Pregnant Women: A Randomized Controlled Trial

Huai-Zhen Wang, Han-Wen Chen, Yan-Ting Fan, Yu-Ling Jing, Xing-Rong Song, Ying-Jun She

Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)

Med Sci Monit 2018; 24:6144-6150

DOI: 10.12659/MSM.909476

Chinese Clinical Trial Registry # ChiCTR-OCH-13003109

Available online:

Published: 2018-09-04

BACKGROUND: The effect of body mass index (BMI) on the spread of spinal anesthesia is not completely clear. The aim of this study was to determine the dose requirements of ropivacaine and the incidence of hypotension in pregnant women with different BMIs during cesarean delivery.
MATERIAL AND METHODS: In this double-blind study, 405 women undergoing elective cesarean delivery were allocated to group S (BMI <25), group M (25 ≤BMI <30), or group L (BMI ≥30). Women in each group were further assigned to receive 7, 8, 9, 10, 11, 12, 13, 14, or 15 mg of spinal ropivacaine.
RESULTS: The ED50 and ED95 values of ropivacaine were 9.487 mg and 13.239 mg in Group S, 9.984 mg and 13.737 mg in Group M, and 9.067 mg and 12.819 mg in Group L. There were no significant differences among the 3 groups (p=0.915). Group L had a higher incidence of hypotension and a greater change in MAP after spinal anesthesia compared to the other 2 groups, and also required more doses of ephedrine than the other 2 groups when a dose of 15 mg ropivacaine was used. The incidence of hypotension had a positive correlation with the dose of ropivacaine (OR=1.453, p<0.001) and gestational age (OR=1.894, p<0.001).
CONCLUSIONS: Spinal ropivacaine dose requirements were similar in the normal BMI range. However, higher doses of spinal ropivacaine were associated with an increased incidence and severity of hypotension in obese patients compared with that in non-obese patients.

Keywords: Anesthesia, Spinal, Body Mass Index, Cesarean Section