The relative motor blocking potencies of epidural bupivacaine and ropivacaine in labor.
Minimal local analgesic concentrations (MLAC) have been used to determine the epidural analgesic potencies of bupivacaine and ropivacaine. There are no reports of the motor blocking potencies of these drugs. We sought to determine the motor block MLAC of both drugs and their relative potency ratio. Sixty ASA physical status I and II parturients were randomized to one of two groups, during the first stage of labor. Each received a 20-mL bolus of epidural bupivacaine or ropivacaine. The first woman in each group received 0.35%. Up-down sequential allocation was used to determine subsequent concentrations at a testing interval of 0.025%. Effective motor block was defined as a Bromage score <4 within 30 min. The up-down sequences were analyzed by using the Dixon and Massey method and probit regression to quantify the motor block minimal local analgesic concentration. Two-sided P < 0.05 defined significance. The motor block minimal local analgesic concentration for bupivacaine was 0.326% (95% confidence interval [CI], 0.285-0.367) and for ropivacaine was 0.497% (95% CI, 0.431-0.563) (P = 0.0008). The ropivacaine/bupivacaine potency ratio was 0.66 (95% CI, 0.52-0.82). This is the first MLAC study to estimate the motor blocking potencies of bupivacaine and ropivacaine. Ropivacaine was significantly less potent for motor block, at 66% that of bupivacaine.


CONCLUSIONS
The results of this study demonstrate that epidural ropivacaine is less potent than epidural bupivacaine in producing motor blockade during labor. The motor block potency relation is similar to the sensory potency ratio for these two drugs.
Lacassie
Héctor J
HJ
Anesthesiology Department, Pontificia Universidad Católica de Chile, Marcoleta 367, 3rd Floor, Santiago, Chile. lacassie@med.puc.cl
Columb
Malachy O
MO
Lacassie
Héctor P
HP
Lantadilla
Rodrigo A
RA
D000328:Adult; D000577:Amides / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D002045:Bupivacaine / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D009046:Motor Neurons / Q000187:drug effects*; D009407:Nerve Block; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine