title: Local anesthetics and mode of delivery: bupivacaine versus ropivacaine versus levobupivacaine.
abstract: BACKGROUND
  The influence of the labor epidural local anesthetic (LA) on mode of delivery has not been adequately studied. In this study, we sought to determine if there is a difference in mode of delivery among parturients who receive epidural bupivacaine, ropivacaine, or levobupivacaine.
  
  
  METHODS
  Nulliparous women at term requesting labor analgesia with a cervical dilation <5 cm were randomized to receive epidural bupivacaine, ropivacaine, or levobupivacaine. Analgesia was initiated with a bolus of 15 mL of 0.0625% of the assigned LA with fentanyl 2 microg/mL. Analgesia was maintained with an infusion of the same solution at 10 mL/h. The primary endpoint was the operative delivery rate (instrumental assisted vaginal delivery plus cesarean delivery).
  
  
  RESULTS
  Ninety-eight women received bupivacaine, 90 ropivacaine, and 34 levobupivacaine (before it was removed from the US market). There was no significant difference in the operative delivery rate (bupivacaine = 46%, ropivacaine = 39%, and levobupivacaine = 32%, P = 0.35) among groups. There was less motor block in the levobupivacaine group when compared with the ropivacaine and bupivacaine groups, P < 0.05. There was no significant difference in the duration of the first or second stage of labor, the total dose of LA received per hour of labor, or neonatal outcome among groups.
  
  
  CONCLUSIONS
  Bupivacaine, ropivacaine, and levobupivacaine all confer adequate labor epidural analgesia, with no significant influence on mode of delivery, duration of labor, or neonatal outcome.
authors: Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY 10029-6574, USA. yaakov.beilin@mountsinai.org
authors: Yaakov
authors: Y
authors: Beilin
authors: Nicole R
authors: NR
authors: Guinn
authors: Howard H
authors: HH
authors: Bernstein
authors: Jeff
authors: J
authors: Zahn
authors: Sabera
authors: S
authors: Hossain
authors: Carol A
authors: CA
authors: Bodian
mesh_terms: D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D005865:Gestational Age; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy; D007747:Labor Stage, First / Q000187:drug effects; D007748:Labor Stage, Second / Q000187:drug effects; D000077554:Levobupivacaine; D010147:Pain Measurement; D010298:Parity; D011247:Pregnancy; D000077212:Ropivacaine; D013997:Time Factors
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine