A Comparison of Three Different Concentrations of Ropivacaine with Fentanyl for Patient-Controlled Epidural Analgesia (original) (raw)
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Journal of Medical Science And clinical Research, 2019
Introduction: Epidural infusion of 0.2% ropivacaine is recommended by the manufacturer for labour analgesia, but lower concentrations may be effective. The present work is a clinical comparative study of different doses of ropivacaine i.e. 0.05%, 0.1% and 0.2%, each with 2 mcg/mL of fentanyl to find out minimum effective concentration of ropivacaine that can be used safely in epidural labor analgesia. Materials and Methods: The study was conducted on sixty (60) parturient of ASA grade I and grade II physical status, in labor, with single fetus, vertex position, between 37-42 weeks gestation with regular contractions (true labor pain) with 4-6 cm cervix dilatation and who had requested labor analgesia. Parturients were then allocated randomly to one of three groups with 20parturients in each group. Group 1 received 0.05% ropivacaine with 2 mcg/mL fentanyl, Group 2 received 0.1% ropivacaine with2 mcg/mL fentanyl and Group 3 received 0.2% ropivacaine with 2 mcg/mL fentanyl. After completion of the study, the nonparametric data of the study was analyzed with Kruskal Wallis test and parametric data of the study was analyzed with ANOVA test and p value of <0.05 was taken as statistically significant. Results: Patient demographics and labor characteristics were comparable in all the groups. Ropivacaine 0.05% with 2 mcg/mL of fentanyl produced adequate analgesia for labor and delivery in only 50% of parturient while ropivacaine 0.1% &ropivacaine0.2% with 2 mcg/mL of fentanyl produced adequate analgesia in 90% of parturient in group II and group III. Reduction in local anesthetic was not associated with any change in incidence of motor block or instrumental deliveries. Conclusion: We concluded that the minimum concentration which can be used safely for labor analgesia with no adverse effect is 0.1% of ropivacaine with 2 mcg/mL fentanyl.
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Epidural infusion of 0.2% ropivacaine is recommended by the manufacturer for labor analgesia, but lower concentrations may be effective. The present work is a clinical comparative study of different doses of ropivacaine i.e. 0.05%, 0.1% and 0.2%, each with 2 mcg/mL of fentanyl to find out minimum effective concentration of ropivacaine that can be used safely in epidural labor analgesia. Materials and Methods: The study was conducted on sixty (60) parturient of ASA grade I and grade II physical status, in labor, with single fetus, vertex position, between 37-42 weeks gestation with regular contractions (true labor pain) with 4-6 cm cervix dilatation and who had requested labor analgesia. Parturients were then allocated randomly to one of three groups with 20 parturients in each group. Group 1 received 0.05% ropivacaine with 2 mcg/mL fentanyl, Group 2 received 0.1% ropivacaine with 2 mcg/mL fentanyl and Group 3 received 0.2% ropivacaine with 2 mcg/mL fentanyl. After completion of the study, the nonparametric data of the study was analyzed with Kruskal Wallis test and parametric data of the study was analyzed with ANOVA test and p value of < 0.05 was taken as statistically significant. Results: Patient demographics and labor characteristics were comparable in all the groups. Ropivacaine 0.05% with 2 mcg/mL of fentanyl produced adequate analgesia for labor and delivery in only 50% of parturient while ropivacaine 0.1% & ropivacaine 0.2% with 2 mcg/mL of fentanyl produced adequate analgesia in 90% of parturient in group II and group III. Reduction in local anesthetic was not associated with any change in incidence of motor block or instrumental deliveries. Conclusion: We concluded that the minimum concentration which can be used safely for labor analgesia with no adverse effect is 0.1% of ropivacaine with 2 mcg/mL fentanyl. Keywords: Epidural, Labor analgesia, Ropivacaine, Fentanyl.
International Journal of Contemporary Medical Research [IJCMR], 2019
Providing effective as well as safe analgesia to the parturients in labour is always a concerned for the anaesthesiologists. We conducted this study to compare the analgesic efficacy and fetomaternal outcome of ropivacaine and bupivacaine at equianalgesic dose with fentanyl in low dose infusion. Material and Methods: This prospective, single blind study was carried on 60 nulliparous parturients of ASA grade I and II, with uncomplicated singleton, term pregnancy. The patients were randomly divided into two groups, to receive bolus dose of either 20 ml of 0.075% Ropivacaine and 0.05% Bupivacaine with fentanyl 2 µg/ml in Group RF and Group BF respectively, followed by infusion at the rate of 10ml/hr. Onset of analgesia, motor block, maternal hemodynamics, mode of delivery and foetal outcome was assessed. Results: Visual Analog Scale (VAS) score < 3 was achieved in 25 min in Group RF as compared to 30 min in Group BF. At 30 min, 77% parturients achieved T 10 as compared to 50% in group BF. Maternal haemodynamics, APGAR score, umbilical cord blood analysis was comparable in both the groups. None of the patients had motor block in both groups. The percentage of instrumental delivery was more in Group RF. Conclusions: The onset of analgesia was faster in Group RF as compared to Group BF. However once the analgesia was established, both the groups had effective and satisfactory analgesia throughout the labour with good foetal outcome. The incidence of instrumental delivery was more in Group RF.
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Addition of fentanyl to bupivacaine or ropivacaine in epidural space will increase duration and quality of analgesia with similar safety profile. Study aimed to compare epidural Inj. Bupivacaine 0.1% + Inj. Fentanyl and Inj. Ropivacaine 0.1% + Inj. Fentanyl for onset, effectiveness and duration of analgesia, to study motor blockade intensity, to study hemodynamic parameters, to study technical and drug related complications in mother and baby and to study acceptability of technique by patient. Material and methods: A prospective interventional study was conducted on 50 adult females with primigravida / multigravida full term pregnancy for epidural analgesia under ASA 1 & 2. Unpaired Student t test was used to interpret the results. Results: Patients got more pain relief and satisfaction with ropivacaine+fentanyl as compare to bupivacaine+fentanyl. Conclusions: Addition of fentanyl to bupivacaine or ropivacaine in epidural space increase duration and quality of analgesia with similar safety profile and reduce the requirement of local anesthetic drugs during labour. It did not hamper ambulation and bearing down of patient and had similar incidence of maternal and fetal outcome, with good patient satisfaction.
Advances in Anesthesiology, 2014
Ropivacaine is an alternative to epidural bupivacaine, with greater selectivity for sensory fibres than motor fibres, thus producing less motor blockade as compared to bupivacaine. The purpose of this study was to evaluate the efficacy of Ropivacaine 0.1% when administered epidurally for the relief of labour pain and to compare it with 0.1% bupivacaine, conducted at Rajindra Hospital Patiala, Baba Farid University of Health and Sciences, on 20 parturients after ethical approval from the institutional review board and obtaining written informed consent. Participants were randomly allocated to the two groups (bupivacaine 0.1% (Sensorcaine) + fentanyl 20 μg versus ropivacaine 0.1% (Ropin) + fentanyl 20 μg). It was observed that ropivacaine 0.1% and bupivacaine 0.1%, with fentanyl 20 μg/mL, produced equivalent analgesia for labour. There were no statistically significant differences in the amount of local anaesthetic used, pain scores, sensory levels, motor blockade, labour duration, mo...
2018
We have performed a randomized, double-blinded comparison of two epidural drug regimens for analgesia in labour. In fentanyl group 40 healthy parturient received 0.2% ropivacaine with fentanyl. In clonidine group 40 healthy parturient received 0.2% ropivacaine with clonidine. Both groups received an initial dose of 10 ml, and top-up dose of 10 ml. The two groups were compared for complete analgesia at 20 min. Hemodynamic changes, height of sensory, patient visual analogue score, mode of delivery, drug dosage requirement, patient assessment of motor blockade. Patient received ropivacaine with fentanyl (median 1.0 Vs. 2.0 p=0.001) is significant. The ropivacaine and fentanyl group was more likely to be pain free in the second stage of labour. There was no significance in patient assessment of motor blockade or mode of delivery between the groups. Pain relief and satisfaction score from patients was consistently better in ropivacaine with fentanyl group.
IP Innovative Publication Pvt. Ltd., 2019
ntroduction: The ideal labour analgesia technique should dramatically reduce the pain of labour, while allowing the parturient to actively participate in the birthing experience. In addition, it should have minimal effect on the fetus and the progress of labour. A randomised prospective comparative clinical study using epidural Inj ropivacaine hydrochloride (0.125%) with Inj fentanyl citrate 2µg/ml was compared with Inj Bupivacaine hydrochloride (0.125%) with Inj fentanyl citrate 2µg/ml for onset and quality of analgesia, incidence of motor block, progress, duration and outcome of labour, incidence of instrumental deliveries and neonatal outcome. Materials and Methods: A total of 65 Full term labouring parturients of ASA I and II grade with cephalic singleton pregnancy from 36 to 42 weeks of gestation having cervical dilatation of 4-5 cm were enrolled in this study. Group R (Ropivacaine): received epidural Inj ropivacaine hydrochloride (0.125%) with inj fentanyl citrate 2µg/ml as a continuous infusion at 6 ml/h after a bolus dose of 15ml of the above drug combination. Group B (Bupivacaine): received epidural Inj bupivacaine hydrochloride (0.125%) with inj fentanyl citrate 2 µg/ml as a continuous infusion at 6 ml/h after a bolus dose of 15ml of the above drug combination. Hemodynamic parameters, onset of analgesia, modified bromage scale for motor blockade, pain scores were documented and compared between the two groups. Results: The mean time for onset of analgesia after the bolus dose via the epidural catheter was also similar in both the groups. It was 16.03 m in ropivacaine group and 15.33 m in bupivacaine group. Verbal pain score and Visual analogue scale were also comparable between the two groups. Motor block was mild (0 to 1) in most of the parturients and did not differ with ropivacaine or bupivacaine treatment. Neonatal outcome was similar in both the groups in our study. All the infants had Apgar score more than 7 at 5 minutes after delivery. Conclusion: We found the combination of ropivacaine (0.125%) with fentanyl (2 ?g/ml) when compared to bupivacaine (0.125%) with fentanyl (2 ?g/ml) as a good alternative drug for labour analgesia with minimal side effects. Keywords: Bupivacaine, Ropivacaine, Fentanyl, Labour analgesia, Epidural.
The Internet Journal of Anesthesiology, 2007
Background: Patient-controlled epidural analgesia (PCEA) is a useful and effective technique in relieving labour pain. In this prospective, randomized, double-blinded study, we aimed to compare analgesic effectiveness and side-effects of fentanyl and clonidine supplementation to ropivacaine for PCEA during labour. Methods: 72 healthy pregnant women in labour were randomly allocated to three groups equally as Group R; 0.125% ropivacaine, Group RF; 0.125% ropivacaine and 1 µgmL-1 fentanyl and Group RC; 0.125% ropivacaine and 0.75 µgmL-1 clonidine solutions. PCEA was applied to the patient with pump programmed as 5 mL bolus dose, 10 min locking time (no basal infusion, no 1-4 hour limit) and 10 mL loading dose (from study solution). Maternal hemodynamics, quality of analgesia (Visual Analogue Scale-VAS), motor block, sedation, maternal and fetal side effects were evaluated. Results: Analgesic usage was found significantly decreased in clonidine supplemented Group RC when compared with Group R (p<0.05) and in fentanyl supplemented Group RF, when compared with Group R (p<0.01) and Group RC (p<0.01). Duration of labour was detected to prolonged in Group RF (p<0.05). Mean arterial blood pressure was significantly lower in Group RC between 15-75 min (p<0.05). Among groups, differences in mode of delivery, VAS, maternal heart rate, sedation, motor block, additional analgesic requirement, side effects, fetal heart rate and Apgar scores were no difference. Conclusions: Fentanyl or clonidine addition to ropivacaine in PCEA for labour decrease local anaesthetic consumption. Furthermore the addition of fentanyl to ropivacaine provides superior analgesia than the addition of clonidine to ropivacaine in mentioned doses.
Background:-Epidural analgesia is the most popular method which can provide excellent pain relief yet, allows the mother to be awake and cooperative during labour. In comparision to bupivacaine, Ropivacaine is less lipid soluble, less cardiotoxic, with less motor block and better haemodynamic stability. Objective:-To study and compare the continuous epidural infusion of Ropivacaine with Fentanyl versus Bupivacaine with Fentanyl for labour analgesia. Methodology:-100 healthy primigravid women, aged 18 to 35 yrs, > than 37 weeks gestation, with spontaneous onset of labour were selected. An epidural catheter was inserted at L2-L3 or L3-L4 level. It was activated after 4cm cervical dilatation with test dose of 3ml 1% lignocaine with 1:200,000 epinepherine. The parturients were randomized into two groups. In Bupivacaine group 8 ml 0.125% Bupivacaine Fentanyl 25 ug followed by continuous infusion of 0.125% Bupivacaine and injection Fentanyl 2 ug /ml at the rate of 6ml/hr was given. In Ropivacaine group 8 ml 0.2% Ropivacaine + Inj Fentanyl 25 ug followed by continuous infusion of 0.2% Ropivacaine with injection Fentanyl 2ug /ml at the rate of 6ml /hr was given. Monitoring was done hrly until they reached 10 cm dilatation and the following data were recorded: maternal blood pressure and heart rate, fetal heart rate, VAS score, motor block , sensory level, mode of delivery, Apgar score, and maternal satisfaction. Results:-In our study, motor block was observed in 13(26%) patients in the Bupivacaine group whereas only five (10%) patients had motor block in Ropivacaine group (P < 0.05) and Eight patients in Bupivacaine group and two patients in Ropivacaine group delivered by assisted vaginal deliveries (P < 0.05). There were no significant differences between the two groups in patient characteristics, maternal haemodynamic variables and patient satisfaction. Conclusion:-Ropivacaine 0.2% combined with fentanyl 2 mcg mL (-1) provided effective analgesia with significantly less motor block and less need.