A clinical study of comparison of effect with 0.15% ropivacaine and fentanyl 2mcg/ml versus 0.125% bupivacaine and fentanyl 2mcg/ml epidurally for labour analgesia
Keywords:Bupivacaine, Epidural analgesia, Fentanyl, Labour analgesia, Ropivacaine
Background: Adequate pain control is vital during labor as it can have negative impacts on maternal and fetal physiology. Epidural Bupivacaine with opioid has been in use for many years. Ropivacaine is almost similar to bupivacaine in terms of onset, duration, and quality of sensory blockade, but it is less toxic and produces less motor blockade.
Methods: Authors did a prospective randomized controlled study on 50 prim gravidas of ASA I category with singleton pregnancy in full-term labor, undergoing normal vaginal delivery, admitted to the antenatal ward requesting labor analgesia. They were randomly divided into two groups of 25 each receiving 8 ml Epidural bolus of either 0.125% Bupivacaine with 2ug/ml Fentanyl or 0.15% Ropivacaine with 2ug/ml Fentanyl by the epidural catheter.
Results: Analgesia in Ropivacaine group lasted 7.84 minutes longer than Bupivacaine group (p<0.001). Only 28% in the Ropivacaine group needed 3 analgesia top-ups or more compared to 76% in Bupivacaine group. No one out of 25 subjects in Ropivacaine group developed motor block, whereas 21 subjects (84%) in Bupivacaine group developed partial motor (grade 2) block. There was no significant difference in maternal or neonatal outcome between the groups.
Conclusions: Subjects in Ropivacaine group on comparison with Bupivacaine group experienced excellent labor analgesia, with greater duration of action, and reduced fentanyl, a local anesthetic requirement with similar VAS scores, maternal and neonatal outcomes besides the major advantage of reduced incidence of motor block.
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