[Epidural anesthesia with ropivacaine vs. bupivacaine in continuous perfusion for the treatment of labor pains].
OBJECTIVE
To compare the analgesic efficacy and extent of motor block when 0.125% ropivacaine or 0.125% bupivacaine were given in continuous perfusion through an epidural catheter during labor.


METHODS
We studied 60 ASA I-II women, each carrying a single fetus at full term and in spontaneous labor. The patients were distributed in 2 groups. Women in the ropivacaine group (R) (n = 30) received 8 mL of 0.2% ropivacaine for analgesic induction, followed by a continuous perfusion of 10 mL/h at 0.125%. The bupivacaine group (B) (n = 30) received bupivacaine at the same concentration and infusion rate. The objective of analgesia was to achieve a score less than 3 on a visual analog pain scale. If analgesia was inadequate, a 5 mL bolus of 0.2% ropivacaine or bupivacaine, depending on group, was administered. The motor block was evaluated on an abbreviated Bromage scale and we recorded hemodynamic stability, fetal status, type of delivery and the total dose of local anesthetic.


RESULTS
Analgesia and hemodynamics were similar in both groups. Group R required a larger number of additional boluses, although the difference was not statistically significant. A motor block was observed in 8 patients in group B and 1 in group R (p < 0.05). Fetal status was similar in both groups.


CONCLUSIONS
Both drugs were equally effective for controlling the pain accompanying labor, such that ropivacaine offered no advantage over bupivacaine in that regard. Ropivacaine's reduced motor block effect at the doses administered may offer an advantage in some situations, such as when a walking epidural is provided.
Fernández
C
C
Servicio de Anestesiología y Reanimación, Corporació Sanitaria Clínic, Universitat de Barcelona. cfernan8@terra.es
Sala
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X
Plaza
A
A
López
A
A
Celemín
M
M
Gomar
C
C
D018663:Adrenergic Agents / Q000627:therapeutic use; D000328:Adult; D000577:Amides / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000779:Anesthetics, Local / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001034:Apgar Score; D002045:Bupivacaine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D005333:Fetus / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy; D007231:Infant, Newborn; D015993:Life Tables; D009043:Motor Activity / Q000187:drug effects; D010147:Pain Measurement; D010477:Perfusion; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
D018663:Adrenergic Agents; D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D004809:Ephedrine; D002045:Bupivacaine
Analgesia epidural con ropivacaína frente a bupivacaína en perfusión continua para tratamiento del dolor del parto.