[Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome].
BACKGROUND
Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome.


METHODS
In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group.


RESULTS
The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA.


CONCLUSIONS
The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.
Vendola
N
N
Divisione di Ostetricia e Ginecologia, Azienda Ospedaliera, Fondazione Macchi, Varese, Italy.
Passani
N
N
Zambello
A
A
Fonzo
R
R
D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001034:Apgar Score; D001724:Birth Weight; D002585:Cesarean Section; D003627:Data Interpretation, Statistical; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage; D013997:Time Factors; D014620:Vacuum Extraction, Obstetrical
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil