A randomized comparison of levobupivacaine, bupivacaine and ropivacaine with fentanyl, for labor analgesia.
BACKGROUND
To compare the analgesic efficacy of epidural infusions of levobupivacaine, bupivacaine and ropivacaine in labor.


METHODS
102 nulliparous parturients in early labor were enrolled in this randomized, double-blind clinical trial. They were randomly assigned to receive one of three continuous epidural infusion regimens: levobupivacaine 0.125%, bupivacaine 0.125% or ropivacaine 0.2%, all with fentanyl 1 microg/mL at 8 mL/h. Supplementary analgesia was provided with an 8-mL epidural bolus of the study solution if visual analogue scale (VAS) score for pain was 40 (0-100 mm). Pain and motor and sensory block were measured at 0, 15 and 30 min, 1, 2, 3 and 4h and full cervical dilatation.


RESULTS
Analgesia was satisfactory in all three groups, with VAS score <40 mm at all measurements. VAS scores were greater in those receiving levobupivacaine (P<0.005). Motor block was greater with bupivacaine than levobupivacaine (P<0.01). There were no differences in motor block between levobupivacaine and ropivacaine. There were no other differences between groups.


CONCLUSIONS
All three regimens were effective during first stage of labor although pain scores were higher in those receiving levobupivacaine. Motor block was greater with bupivacaine than with levobupivacaine.
Atiénzar
M C
MC
Department of Anesthesia, Hospital General Castellón, Castellón, Spain. carmen.atienzar@uv.es
Palanca
J Ma
JM
Torres
F
F
Borràs
R
R
Gil
S
S
Esteve
I
I
D000759:Adjuvants, Anesthesia; D000328:Adult; D000577:Amides; D015360:Analgesia, Epidural / Q000379:methods; D016362:Analgesia, Obstetrical / Q000379:methods*; D000704:Analysis of Variance; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D000077554:Levobupivacaine; D009043:Motor Activity / Q000187:drug effects; D010147:Pain Measurement / Q000706:statistics & numerical data; D011247:Pregnancy; D000077212:Ropivacaine; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D000577:Amides; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine