Comparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia.

BACKGROUND Several studies have been performed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus. We aimed to compare the efficacy and side effects of epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl at low concentrations. METHOD Forty ASA I-II parturients' were included in this prospective, double-blind, trial and randomized to receive either bupivacaine or ropivacaine for labor analgesia. Analgesia was initiated with 8 mL of 0.125% solution plus fentanyl 50 microg and maintained with a continuous infusion of 0.0625% solution with fentanyl 2 microg/mL. RESULTS There were no differences in pain scores, total dose of local anesthetics used, sensory or motor blockade, labor duration, mode of delivery, side effects, patient satisfaction, or neonatal outcome between the two local anesthetics at these dosages, but at the end of the second stage and delivery, adequate analgesia quality could not be ensured. CONCLUSION We found no major advantage of continuous epidural infusion of ropivacaine 0.0625% plus fentanyl 2 microg/mL over bupivacaine 0.0625% plus fentanyl 2 microg/mL for labor analgesia. We believe that different methods or dosages may be tried in order to improve comfort at the second stage of labor and the delivery.

[1]  D. Bick,et al.  Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial , 2001, The Lancet.

[2]  B. Gutsche,et al.  Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis. , 1998, British journal of anaesthesia.

[3]  S. Shnider,et al.  Anesthesia for Obstetrics , 1993 .

[4]  C. Amiel‐Tison,et al.  A NEW NEUROLOGIC AND ADAPTIVE CAPACITY SCORING SYSTEM FOR EVALUATING OBSTETRIC MEDICATIONS IN FULL-TERM NEWBORNS , 1980 .

[5]  M. Columb,et al.  Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. , 1998, Anesthesiology.

[6]  M. Kock,et al.  A double-blind comparison of 0.125% ropivacaine with sufentanil and 0.125% bupivacaine with sufentanil for epidural labor analgesia. , 1999, Anesthesiology.

[7]  T. Brazelton,et al.  Use and abuse of neonatal neurobehavioral testing. , 2000, Anesthesiology.

[8]  D. Moir.  Local anaesthetic techniques in obstetrics. , 1986, British journal of anaesthesia.

[9]  R. Russell,et al.  Epidural infusion of low‐dose bupivacaine and opioid in labour Does reducing motor block increase the spontaneous delivery rate? , 1996, Anaesthesia.

[10]  L. V. Eps.  The pain of childbirth , 1955 .

[11]  G. Lyons,et al.  Relative potencies of bupivacaine and ropivacaine for analgesia in labour. , 1999, British journal of anaesthesia.

[12]  R. Gaver,et al.  A Comparison of Epidural Analgesia with 0.125% Ropivacaine with Fentanyl Versus 0.125% Bupivacaine with Fentanyl during Labor , 2000, Anesthesia and analgesia.

[13]  M. Mongelli,et al.  Oxygen free radical activity in the second stage of labor , 1997, Acta obstetricia et gynecologica Scandinavica.

[14]  J. Bonica,et al.  THE MANAGEMENT OF PAIN , 1954 .

[15]  J. Hauth,et al.  Umbilical cord pH, PCO2, and bicarbonate following uncomplicated term vaginal deliveries. , 1985, American journal of obstetrics and gynecology.

[16]  G. Lyons,et al.  Extradural pain relief in labour: bupivacaine sparing by extradural fentanyl is dose dependent. , 1997, British journal of anaesthesia.

[17]  H. Muir,et al.  Double-blind comparison of epidural ropivacaine 0.25% and bupivacaine 0.25%, for the relief of childbirth pain , 1997, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[18]  Shiv k. Sharma,et al.  Analgesia in labour and fetal acid–base balance: a meta‐analysis comparing epidural with systemic opioid analgesia , 2002, BJOG : an international journal of obstetrics and gynaecology.

[19]  K. Blakemore,et al.  A comparison of the effect of epidural, general, and no anesthesia on funic acid-base values by stage of labor and type of delivery. , 1990, American journal of obstetrics and gynecology.

[20]  J. V. van Kleef,et al.  Ropivacaine 0.25% Versus Bupivacaine 0.25% for Continuous Epidural Analgesia in Labor: A Double-Blind Comparison , 1995, Anesthesia and analgesia.

[21]  J. Eisenach,et al.  0.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patient-controlled epidural infusion. , 1998 .

[22]  A. van Assche,et al.  The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labor and on the incidence of instrumental deliveries. , 1991, Anesthesiology.

[23]  P. Popham,et al.  Low dose bupivacaine/fentanyl epidural infusions in labour and mode of delivery , 1994, Anaesthesia.

[24]  D. Chestnut.  Does Epidural Analgesia During Labor Affect the Incidence of Cesarean Delivery? , 1997, Regional Anesthesia & Pain Medicine.

[25]  D. Swaab,et al.  Oxytocin deficiency at delivery with epidural analgesia , 1983, British Journal of Obstetrics and Gynaecology.

[26]  S. García del Valle,et al.  A Comparison of 0.0625% Bupivacaine with Fentanyl and 0.1% Ropivacaine with Fentanyl for Continuous Epidural Labor Analgesia , 2001, Anesthesia and analgesia.

[27]  W. Korevaar.  The Management of Pain, 2nd ed. , 1991 .