Epidural labor analgesia: a comparison of mixture of ropivacaine 0.125% with fentanyl versus ropivacaine 0.2% with fentanyl
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20222472Keywords:
Epidural, Fentanyl, Labor analgesia, Local anesthetics, RopivacaineAbstract
Background: Ropivacaine is more selective for sensory fibers when compared to other local anesthetics, producing less motor block. This permits better maternal ambulation and also allows for normal progression of labor, which translates into lesser instrumental deliveries and higher vaginal deliveries. Objective was to evaluate 0.125% versus 0.2% ropivacaine, with 2 μg/ml of fentanyl in epidural labor analgesia, regarding their sensory and motor block characteristics.
Methods: This prospective study was conducted among 40 patients, 20 in each group [group A (0.125% ropivacaine with 2 µg/ml fentanyl), group B (0.2% ropivacaine with 2 µg/ml fentanyl)], for epidural labor analgesia in obstetrics and gynecology department (labor room). The efficacy of the drugs was tested by comparing the onset of analgesia, duration of labor analgesia, dose requirement, pulse, BP, sensory effect, motor effect, FHR, APGAR score and side effects.
Results: Total duration of labor analgesia was 230.25 minutes with 55.68 SD and 186.25 minutes with 57.7 SD in group A and group B respectively (p<0.05). The total dose of ropivacaine used was 81.00 mg and 68.50 mg in group A and B respectively (p<0.05). Total dose of fentanyl required was 94.50 µg and 73.50 µg in group A and group B respectively (p<0.05). There was no significant difference found in hemodynamic parameters in both groups.
Conclusions: Both the concentrations are effective in producing epidural labor analgesia. However, onset of analgesia was significantly faster with 0.2% ropivacaine. The required dose of ropivacaine was significantly higher in 0.125% ropivacaine. 0.2% ropivacaine shorten the duration of labor compared to 0.125% ropivacaine.
Metrics
References
Pandya ST. Labour analgesia: recent advances. Indian J Anaesth. 2010;54(5):400-8.
Carrie LE, O’Sullivan GM, Seegobin R. Epidural fentanyl in labour. Anaesthesia. 1981;36:965-9.
Karhade SS, Sardesai SP. 0.2% ropivacaine with fentanyl in the management of labor analgesia: a case study of 30 parturients. Anesth Essays Res. 2015;9(1):83-7.
Nancarrow C, Rutten AJ, Runciman WB, Mather LE, Carapetis RJ, McLean CF, et al. Myocardial and cerebral drug concentrations and the mechanisms of death after fatal intravenous doses of lidocaine, bupivacaine, and ropivacaine in the sheep. Anesth Analg. 1989;69:276-83.
Zaric D, Nydahl PA, Philipson L, Samuelsson L, Heierson A, Axelsson K. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2%, and 0.3%) and 0.25% bupivacaine on sensory and motor block in volunteers: a double-blind study. Reg Anesth. 1996;21:14-25.
Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: A randomised controlled trial. Lancet. 2001;358:19-23.
Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Engl J Med. 1997;337:1715-9.
Dewandre PY. The right drug and dose for neuraxial labour analgesia. Acta Anaesthesiol Belg. 2006;57:395-9.
Chhetty YK, Naithani U, Gupta S, Bedi V, Agrawal I, Swain L. Epidural labor analgesia: a comparison of ropivacaine 0.125% versus 0.2% with fentanyl. J Obstet Anaesth Crit Care. 2013;3:16-22.
Handley G, Perkins G. The addition of pethidine to epidural bupivacaine in labour- effect of changing bupivacaine strength. Anaesth Intens Care. 1992;20:151-5.
Duggan J, Bowler GM, McClure JH, Wildsmith JA. Extradural block with bupivacaine: Influence of dose, volume, concentration and patient characteristics. Br J Anaesth. 1988;61:324-31.
Lee BB, Ngan Kee WD, Wong EL, Liu JY. Dose-response study of epidural ropivacaine for labor analgesia. Anesthesiology. 2001;94:767-72.
Ngan Kee WD, Ng FF, Khaw KS, Lee A, Gin T. Determination and comparison of graded dose-response curves for epidural bupivacaine and ropivacaine for analgesia in laboring nulliparous women. Anesthesiology. 2010;113:445-53.
Debon R, Allaouchiche B, Duflo F, Boselli E, Chassard D. The analgesic effect of sufentanil combined with ropivacaine 0.2% for labor analgesia: a comparison of three sufentanil doses. Anesth Analg. 2001;92(1):180-3.
Eddleston JM, Holland JJ, Grifi RP, Corbett A, Horsman EL, Reynolds F. A double-blind comparison of 0.25% ropivacaine and 0.25% bupivacaine for extradural analgesia in labour. Br J Anaesth. 1996;76:66-71.
McCrae AF, Jozwiak H, McClure JH. Comparison of ropivacaine and bupivacaine in extradural analgesia for the relief of pain in labour. Br J Anaesth. 1995;74:261-5.
Beilin Y, Galea M, Zahn J, Bodian CA. Epidural ropivacaine for the initiation of labor epidural analgesia: a dose finding study. Anesth Analg. 1999;88:1340-5.
Bang EC, Shin JH, Lee HS, Kang YI, Cho KS, Kim SY. The onset and duration of 0.2% ropivacaine with a varying dose of fentanyl in epidural labor analgesia. Anesth Pain Med. 2010;5:249-54.
Purdie NL, McGrady EM. Comparison of patient-controlled epidural bolus administration of 0.1% ropivacaine and 0.1% levoropivacaine, both with 0.0002% fentanyl, for analgesia during labour; Anaesthesia. 2004;59:133-7.
Downloads
Published
How to Cite
Issue
Section
