title: Efficacy of ropivacaine, bupivacaine, and levobupivacaine for labor epidural analgesia.
abstract: OBJECTIVE
  To compare analgesic efficacy and intensity of motor block with continuous infusions of ropivacaine, bupivacaine, and levobupivacaine in combination with fentanyl for labor epidural analgesia.
  
  
  METHODS
  Prospective, randomized, double-blinded study.
  
  
  METHODS
  Labor and delivery suite at Magee Womens Hospital, Pittsburgh, PA.
  
  
  METHODS
  162 ASA physical status I and II, full-term, primiparous women.
  
  
  METHODS
  All patients received epidural labor analgesia. Epidural medication consisted of an initial bolus of 8 mL local anesthetic with fentanyl (100 microg) followed by an infusion at 12 mL/h of local anesthetic with 2 microg/mL fentanyl. Patients were allocated to one of three groups, as follows: group 1 received bolus and infusion of bupivacaine 0.125%, group 2 received bolus and infusion of levobupivacaine 0.125%, and group 3 received a bolus of ropivacaine 0.2% and infusion of ropivacaine 0.1%.
  
  
  METHODS
  Maternal vital signs, pain visual analog scale (VAS) score, sensory levels, and motor block (Bromage score) were recorded every hour. Duration of first and second stage of labor and mode of delivery were also recorded.
  
  
  RESULTS
  There were no statistically significant differences in pain VAS or Bromage motor scores among the three groups of patients at any of the measured time intervals. The time to achieve T10 sensory level and patient comfort was shorter in the ropivacaine (9.35 +/- 4.96 min) and levobupivacaine (9.56 +/- 4.71 min) groups than the bupivacaine (11.89 +/- 7.76 min) group, although this difference did not reach a statistically significant level (P = 0.06). The second stage was significantly shorter in the bupivacaine group, lasting 81.27 +/- 63.3 min, compared with the ropivacaine group (121.69 +/- 86.5 min) and the levobupivacaine (115.5 +/- 83.6 minutes) group (P = 0.04).
  
  
  CONCLUSIONS
  There are no significant differences in pain VAS and Bromage scores between 0.1% ropivacaine, 0.125% bupivacaine, and 0.1% levobupivacaine given for labor epidural analgesia.
authors.affiliation: Department of Anesthesiology, Magee Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. sahxnb@anes.upmc.edu
authors.forename: Neera
authors.initials: N
authors.lastname: Sah
authors.forename: Manuel
authors.initials: M
authors.lastname: Vallejo
authors.forename: Amy
authors.initials: A
authors.lastname: Phelps
authors.forename: Helene
authors.initials: H
authors.lastname: Finegold
authors.forename: Gordon
authors.initials: G
authors.lastname: Mandell
authors.forename: Sivam
authors.initials: S
authors.lastname: Ramanathan
mesh_terms: D000328:Adult; D000577:Amides; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D000077554:Levobupivacaine; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D002045:Bupivacaine