title: Effects of intrapartum epidural analgesia at high altitudes: maternal, fetal, and neonatal outcomes. A randomized controlled trial of two formulations of analgesics.
abstract: OBJECTIVE
  To investigate whether intrapartum epidural analgesics (bupivacaine or ropivacaine) have an influence (safety and efficacy) on mothers, fetuses, or newborns at high altitudes (2,200 m above the sea level).
  
  
  METHODS
  Prospective randomized trial.
  
  
  METHODS
  A tertiary referral hospital in Aseer region, Saudi Arabia.
  
  
  METHODS
  Eighty parturient women with normal full term pregnancy (37-40 weeks) were randomly allocated to a group receiving epidural bupivacaine 0.125% and the other receiving ropivacaine 0.2%, with fentanyl 100 microg given to both groups.
  
  
  METHODS
  Intra- and postpartum clinical management of the pregnant women and newborns and fetal Doppler assessments were performed.
  
  
  METHODS
  Severity of pain, onset and duration of analgesia, and occurrence of motor blockade were primary outcomes. Progress of labor, need for oxytocin augmentation, mode of delivery, and neonatal condition were secondary outcomes.
  
  
  RESULTS
  Demographic, labor characteristics, and neonatal outcomes of the two groups were comparable. The onset of analgesia was relatively more rapid for ropivacaine group (p = 0.067). Duration of analgesia after the first bolus dose was longer and the need for supplemental epidural analgesic doses was lesser in the bupivacaine group (p = 0.041 and 0.045, respectively). In both groups, the fetal umbilical and middle cerebral artery pulsatility indices showed significant change when compared to the baseline of the same group.
  
  
  CONCLUSIONS
  At high altitudes, no major advantage was found for epidural ropivacaine over bupivacaine in addition to fentanyl for labor analgesia and no harmful effects of the medications were found on mothers, fetuses, or newborns.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt. mshromih@yahoo.com
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Shokry
authors.forename: Essam M
authors.initials: EM
authors.lastname: Manaa
authors.forename: Randa Ali
authors.initials: RA
authors.lastname: Shoukry
authors.forename: Mohamed Hossam
authors.initials: MH
authors.lastname: Shokeir
authors.forename: Ghada O
authors.initials: GO
authors.lastname: Elsedfy
authors.forename: Abd El-Salam
authors.initials: Ael-S
authors.lastname: Abd El-Aziz
mesh_terms: D000293:Adolescent; D000328:Adult; D000531:Altitude; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D001034:Apgar Score; D001274:Atmospheric Pressure; D002045:Bupivacaine / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology; D010147:Pain Measurement; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D000077212:Ropivacaine; D012529:Saudi Arabia; D047929:Term Birth; D016216:Ultrasonography, Prenatal; D055815:Young Adult
chemical_list: D000577:Amides; D000077212:Ropivacaine; D005283:Fentanyl; D002045:Bupivacaine