Ropivacaine versus bupivacaine 0.125% with fentanyl 1 microg/ml for epidural labour analgesia: is daily practice more important than pharmaceutical choice?
Ropivacaine might be superior to bupivcaine for epidural labour analgesia because it appears to induce less lower extremity motor blockade. The clinical relevance of this difference is not yet clear.


METHODS
In a double-blind randomised trial bupivacaine and ropivacaine each at 0.125% with 1 microg/ml fentanyl were compared for epidural labour analgesia. This study was performed in two university hospitals.


RESULTS
Sixty-three nulliparous women with singleton pregnancies at term were included. There were no differences between bupivacaine and ropivacaine as far as motor blockade, analgesic outcome, mode of delivery and neonatal outcome are concerned. However, the clinical management of epidural analgesia differed significantly between the two institutions involved. Parturients of one institution had their epidural catheter placed earlier, needed less top-up medication, and had more successful mobilisations, when compared to the other institution.


CONCLUSIONS
Institutional clinical practice can be significantly different. Pharmacological differences between bupivacaine and ropivacaine at 0.125% with 1 microg/ml fentanyl seem to be less important than differences between institutions in terms of clinical practice.
Girard
T
T
Department of Anaesthesia, University Hospital, Kantonsspital Basel, CH-4031 Basel, Switzerland. thierry.girard@unibas.ch
Kern
C
C
Hösli
I
I
Heck
A
A
Schneider
M C
MC
D000759:Adjuvants, Anesthesia; D000328:Adult; D000577:Amides; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D007231:Infant, Newborn; D019148:Neuromuscular Blockade; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl; D002045:Bupivacaine