In this prospective meta-analysis, we have evaluated the effect of epidural analgesia with ropivacaine for pain in labour on neonatal outcome and mode of delivery compared with bupivacaine. In six randomized, double-blind studies, 403 labouring women, primigravidae and multiparae, received epidural analgesia with ropivacaine or bupivacaine 2.5 mg ml-1. The drugs were administered as intermittent boluses in four studies and by continuous infusion in two. Apgar scores, neurological and adaptive capacity scores (NACS), degree of motor block and mode of delivery were recorded. The studies were designed prospectively to fit meta-analysis of the pooled results. Results showed similar pain relief and consumption of the two drugs. In the vaginally delivered neonates, NACS scores were approximately equal for both groups at 2 h, but at 24 h there were fewer infants with NACS less than 35 in the ropivacaine compared with the bupivacaine group (2.8% vs 7.6%; P < 0.05). Spontaneous vaginal deliveries occurred more frequently overall with ropivacaine than with bupivacaine (58% vs 49%; P < 0.05) and instrumental deliveries (forceps and vacuum extraction) less frequently (27% vs 40%; P < 0.01), while the frequency of Caesarean section was similar between groups. The intensity of motor block was lower with ropivacaine. There were no significant differences in adverse events.

Seventy-three parturients for elective Caesarean section were allocated randomly to receive extradural block with 20 ml of either 0.5% ropivacaine or 0.5% bupivacaine. If the block did not reach T6 within 30 min, another 5 ml of solution was given. If needed, a further 5 ml was given 45 min after the main dose. The mean total dose of bupivacaine was 23.1 ml (n = 35) and of ropivacaine 23.7 ml (n = 37). There was no significant difference between the groups in the profile of sensory block produced. There was no significant difference in the time of onset, or intensity of motor block between the groups but the duration of motor block was significantly shorter in the ropivacaine group. There was no significant difference in neonatal outcome, as assessed by Apgar score, umbilical cord blood-gas tensions at delivery or the neurological and adaptive capacity score 2 and 24 h after delivery.

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.

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In brief: A medical team kept records for four years on all injuries that occurred during an annual state championship rodeo. Fifty-five (19.7%) of the 278 competitors and rodeo clowns who participated sustained a total of 61 injuries. Bull riding was the most dangerous event, accounting for 20 injuries to 18 competitors; saddle bronc riding and bareback riding followed with 13 injuries each. Barrel racing was the safest, with no injuries. The most common injuries were contusions, sprains, and strains, and the elbow was injured more often than any other part of the body. Protective equipment and physical conditioning could reduce rodeo injuries.