A randomized controlled double blind study comparing the efficacy of epidural ropivacaine and bupivacaine with fentanyl for labor analgesia (original) (raw)
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Journal of Anaesthesiology Clinical Pharmacology, 2016
Background and Aims: Ropivacaine is considered as a safe alternative to bupivacaine for labor analgesia. The aim was to compare epidural ropivacaine and bupivacaine in intermittent doses for obstetric analgesia. Material and Methods: In this prospective, randomized, double-blind study, 60 women in labor were randomly allocated to receive either bupivacaine 0.1% with fentanyl 2 μg/mL (BF), or ropivacaine 0.1% with fentanyl 2 μg/mL (RF). Bromage scale, loss of cold sensation to ether swab in midclavicular line, visual analog scale were used to test for motor block, sensory block and pain, respectively. Hemodynamic parameters, onset of analgesia, dose requirement of drug to produce analgesia, duration of labor, and incidence of side effects were also recorded. Data were expressed as mean ± standard deviation and analyzed using students unpaired t-test, Chi-square and Mann-Whitney U-tests at P < 0.05. Results: Both drugs were similar with respect to hemodynamic stability, onset of analgesia, quality of analgesia, sensory blockade, neonatal outcome, requirement of drugs, duration of labor, and incidence of side effects. Three parturient in bupivacaine (B-F) group had a motor block of Bromage 1 and were delivered using forceps. None of the parturient in ropivacaine (R-F) group had any motor block, and all had spontaneous vaginal delivery, but this difference was not statistically significant (P = 0.081). Conclusions: Bupivacaine and ropivacaine provide equivalent analgesia in low (0.1%) concentration.
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.
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.
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...
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.
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.
British Journal of Anaesthesia, 1996
Ropivacaine is a new aminoamide local anaesthetic. Compared with bupivacaine, ropivacaine possesses a higher threshold for systemic toxicity and a high selectivity for sensory fibres. We have compared prospectively these two agents in a concentration of 0.25 % for extradural analgesia in labour. A total of 104 parturients requesting extradural analgesia were randomized to receive either ropivacaine or bupivacaine. The women in the bupivacaine group required more top-up doses to maintain analgesia (median 3.0 vs 2.0) (P : 0.05). The onset of sensory block, quality of analgesia, ultimate level of maximum sensory block and maternal satisfaction were similar in both groups. The incidence, intensity and duration of motor block were slightly but not significantly less in the ropivacaine group. The ropivacaine group had a higher incidence of spontaneous vaginal delivery (70.59 % vs 52.00 %). There was no significant difference in neonatal outcome as assessed by Apgar scores, umbilical acid-base status and neurological and adaptive capacity score at 2 and 24 h after delivery. We conclude that ropivacaine and bupivacaine in a concentration of 0.25 % produced comparable analgesia for pain relief of labour with no detectable adverse effect on the neonate. (Br.
Acta Anaesthesiologica Scandinavica, 2002
In recent studies, minimum local analgesic concentrations have been defined as 0.93 mg/mL for bupivacaine and 1.56 mg/mL for ropivacaine for epidural analgesia for the first stage of labour, resulting in an analgesic potency ratio of 1 : 0.6. In the current study we compared ropivacaine and bupivacaine in a PCEA system (combined with sufentanil) taking this potency ratio into account but administering drug doses providing sufficient analgesia for all stages of labour. Methods: In a prospective, double-blinded study 114 parturients were randomised to receive either ropivacaine 2 mg/mL with sufentanil 0.75 mg/mL or bupivacaine 1.25 mg/with sufentanil 0.75 mg/mL. After epidural catheter placement, PCEA was available with boluses of 4 mL, a lock-out time of 20 min and no basal infusion rate. We evaluated pain intensity during contractions, sensory and motor function, duration of labour, mode of delivery and neonatal outcome. Consumption of local anaesthetic and opioid drugs and PCEA system variables were recorded. Results: Mean total consumption as well as mean hourly drug consumption was significantly increased in the ropivacaine-su-
International journal of obstetric anesthesia, 2004
The objective was to evaluate the influence of patient-controlled epidural analgesia (PCEA) using low doses of bupivacaine vs. ropivacaine, on labor pain, motor blockade, progression of labor, delivery and neonatal outcome. This randomized double blind study included 565 parturients. All received a 5-mL/h infusion and PCEA (5-mL boluses with a 20-min lockout, maximum volume 20 mL/h) of either 0.125% bupivacaine (n = 313: 165 nulliparous, 148 parous) or 0.2% ropivacaine (n = 252: 113 nulliparous, 139 parous). Pain score, lower limb motor block, sensory levels, local analgesic doses required, hemodynamic parameters, side effects and complications were assessed. Obstetric variables included cervical dilation at epidural insertion, incidence of ruptured membranes and their duration, use of oxytocin, fetal heart rate changes, duration of labor, mode and outcome of delivery, and use of invasive and non-invasive fetal monitoring. Neonatal characteristics included birth weight, Apgar scores...
Relative potencies of bupivacaine and ropivacaine for analgesia in labour
British Journal of Anaesthesia, 1999
We have used the technique of randomized, double-blind sequential allocation to compare the minimum local analgesic concentrations (MLAC) of epidural bupivacaine and ropivacaine for women in the first stage of labour. The test bolus was 20 ml of local anaesthetic solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of local anaesthetic, according to up-down sequential allocation. Efficacy was assessed using a 100-mm visual analogue pain score (VAPS). The test solution had to achieve a VAPS of 10 mm or less to be judged effective. For bupivacaine, MLAC was 0.093 (95% CI 0.076-0.110)% w/v, and for ropivacaine, 0.156 (95% CI 0.136-0.176)%w/v (PϽ0.0001, 95% CI difference 0.036-0.090). The analgesic potency of ropivacaine was 0.60 (0.47-0.75) relative to bupivacaine. Claims for reduced toxicity and motor block must be considered with differences in analgesic potency in mind.