Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125%-- fentanyl infusions for epidural labour analgesia.
OBJECTIVE
To compare analgesic efficacies of ropivacaine-fentanyl and bupivacaine-fentanyl infusions for labour epidural analgesia.


METHODS
In this double- blind, randomized study 100, term, nulliparous women were enrolled. Lumbar epidural analgesia (LEA) was started at cervical dilatation < 5 cm using either bupivacaine 0.25% followed by bupivacaine 0.125% + 2 microg x ml(-1) fentanyl infusion (n=50) or ropivacaine 0.2% followed by ropivacaine 0.1% + 2 microg x ml(-1) fentanyl infusion (n=50). Every hour maternal vital signs, visual analog scale (VAS) pain score, sensory levels, and motor block (Bromage score) were assessed. Data were expressed as mean +/-1 SD and analyzed using Chi -Squared and Mann-Whitney U tests at <0.05.


RESULTS
The onset times were 10.62+/-4.9 and 11.3+/-4.7 min for the bupivacaine and ropivacaine groups respectively (P = NS). The median VAS scores were not different between the groups at any of the evaluation periods. However, at least 80% of patients in the ropivacaine group had no demonstrable motor block after the first hour compared with only 55% of patients given bupivacaine (P =0.01).


CONCLUSIONS
Both bupivacaine and ropivacaine produce satisfactory labour analgesia. However, ropivacaine infusion is associated with less motor block throughout the first stage of labour and at 10 cm dilatation.
Finegold
H
H
Department of Anesthesiology and Critical Care Medicine, The University of Pittsburgh School of Medicine, Magee--Women's Hospital, Pennsylvania 15213, USA. Finegold@anes.upmc.edu
Mandell
G
G
Ramanathan
S
S
D000328:Adult; D000577:Amides / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D002045:Bupivacaine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D011247:Pregnancy; D000077212:Ropivacaine; D013599:Systole / Q000187:drug effects
D000577:Amides; D000077212:Ropivacaine; D005283:Fentanyl; D002045:Bupivacaine