A comparison of 0.1% ropivacaine and 0.1% bupivacaine with patient-controlled epidural analgesia for labor: a double blind study

Abstract

Objective: Ropivacaine has been claimed to be superior for epidural labor analgesia, with less motor blockade and toxicity as compared to bupivacaine, and it has largely replaced the later drug for this purpose.

The objective of this study was to compare and evaluate the analgesic efficacy of ropivacaine 0.1% and bupivacaine 0.1% with 2 μg/ml fentanyl for painless labor using patient-controlled epidural analgesia (PCEA).

Methodology: This prospective, randomized and double blind study was undertaken in a tertiary care hospital. Fifty parturients of ASA grade I and II, were randomly allocated into two groups of 25 each, to receive either 10 ml of 0.1% bupivacaine or 0.1% ropivacaine with fentanyl 2μg/ml in Group B and Group R respectively as initial bolus dose. Same dose regimen was used as continuous background infusion and PCEA boluses of 10 ml according to the group allocation. Onset and quality of analgesia, motor weakness, total drug consumption, and fetomaternal outcome in both groups were compared.

Results: Effective labor analgesia (VAS < 30) with onset time of 9.42 ± 1.16 and 9.14 ± 1.46 min in Group B and Group R respectively were comparable in both the groups (p > 0.05). All the patients were pain free within 15 min after initiation of epidural analgesia. Sensory and motor block characteristics in both the groups were comparable. No patient had motor blockade till two hours after initiation of epidural analgesia. Motor block increased as the duration of labor increased. Overall, drug consumption was 85.04 ± 21.02 ml in Group R and 81.56 ± 22.81 ml in Group B with fentanyl during labor (p > 0.05). There were no significant changes in hemodynamic parameters, duration of labor or maternal satisfaction. No adverse effects related to neonatal or maternal outcomes were noted in both groups.

Conclusion: We conclude that 0.1% ropivacaine or 0.1% bupivacaine, with fentanyl 2 μg/ml using PCEA, were equally effective for labor analgesia. There were no statistically significant differences in the quantity of drug used, motor weakness, labor duration, or fetomaternal outcome.

Key words: Labor analgesia; Bupivacaine; Ropivacaine; Fentanyl; Patient-controlled epidural analgesia

Citation: Anand LK, Sarna R, Mitra S. A comparison of 0.1% ropivacaine and 0.1% bupivacaine plus fentanyl with patient-controlled epidural analgesia for labor: a double blind study. Anaesth Pain & Intensive Care 2016;20(3):278-284

Received: 10 March 2016; Reviewed: 11 April & 22 June 2016; Corrected: 28 March & 20 August; Accepted: 31 August 2016