Background & objective: Childbirth is an important phenomenon in the life of the mother and although this experience is the wish of every mother, it also concerns her due to the labor pain and the possible dangers that threaten her. There are several medications for painless delivery, such as epidural analgesia with the help of bupivacaine and ropivacaine. The aim of this study was to compare the efficacy of painless delivery with epidural method by bupivacaine and ropivacaine in women candidates for painless delivery. Methodology: This study is a double blind randomized clinical trial. In this study, patients were randomly divided into two equal groups of bupivacaine and ropivacaine using cubic random method. The demographic data, incidence of cesarean section and mean birth phases were evaluated. Finally, data were analyzed using SPSS 22 software, ANOVA and T-test. Results: A total of 112 patients were enrolled in the study. There was no significant difference between the two groups in terms of mean active phase of labor, mean Apgar score of min 1 and 5, incidence of cesarean section and mothers motor block score, but the mean of the second phase of labor and mean use of delivery helping instruments (such as forceps and vacuum) were lower in the ropivacaine group. Also, the mean score of patients' satisfaction was higher in ropivacaine group. Conclusion: It could be concluded that the combination of ropivacaine and fentanyl versus the combination of bupivacaine and fentanyl was a very suitable combination for controlling labor pain by epidural method, while it did not increase the rate of cesarean section and did not have a negative effect on neonatal Apgar scores of min 1 and 5, it had a significant effect on decreasing the mean of second stage of labor, decreasing the use of delivery helping instruments and increasing patient satisfaction score. Key words: Bupivacaine; Ropivacaine; Epidural analgesia; Painless delivery Citation: Anousheh N, Shokrpour M, Pazouki S, Kamali A. A double blind randomized clinical trial to compare the efficacy of bupivacaine and ropivacaine for painless delivery. Anaesth. pain intensive care 2021;25(3): 274–279.  DOI: doi.org/10.35975/apic.v25i3.1146 Received: November 2, 2020, Reviewed: February 22, 2021, Accepted: March 26, 2021

Background and Aim: One of the most complex medical problems is pain, that due to inappropriate management of patients after surgery could cause various side effects on the psychological, physiological, and metabolic state of the patients. The natural duration of analgesia can be increased by adding new efficient adjuvant. The present study is mainly aimed to investigate the differences between the epidural dexmedetomidine and ketamine effectiveness when administered as an adjuvant to epidural 0.25% bupivacaine for improving the postoperative analgesia duration. Methods: In the present double-blind clinical study, 105 patients of the age range of 40–85 years were selected for elective femoral surgery and then was divided into three of ketamine, dexmedetomidine, and control randomly. The scores of postoperative pain were evaluated in accordance with the visual Analogue Scale (VAS) criteria and the duration of analgesia and the amount of analgesics consumption were recorded. Results: The mean pain VAS score during the first day after the surgery and recovery of patients in the dexmedetomidine group was significantly lower in comparison with two other groups ( p = 0.01). However, no significant difference was found in the mean VAS score of Paine during 12 and 24 hours after the operation ( P ≥ 0.05). Comparisons among these groups demonstrated that the mean on opioid administration during the operation and 24 hours after that was significantly higher in both groups of ketamine and control in comparison with the dexmedetomidine group ( P = 0.001 and P = 0.01). Besides, analgesia duration among patients belonged to the dexmedetomidine group was notably lower in comparison with two other groups ( P = 0.001). Conclusion: In epidural anesthesia cases adding ketamine and dexmedetomidine as adjuvants to the solution of bupivacaine 0.25%, could increase the duration of analgesia and reduce the consumption of analgesics, which is more in the dexmedetomidine group when compared with ketamine.

Introduction: Today, hysterectomy is one of the commonest types of surgery and is the one of the most prevalent surgical procedures in the United States after cesarean section (C-section). One of the important complications of hysterectomy is postoperative pain. To relieve this pain, various methods are used, including the use of analgesics such as intraperitoneal ketamine, dexmedetomidine and bupivacaine. Therefore, the present study is aimed to conduct a comparative study on the effect of intraperitoneal ketamine, dexmedetomidine and bupivacaine on postoperative pain control in patients undergoing abdominal hysterectomy. Materials and Methods: The present study is a randomized, double-blind clinical trial which performed on 105 patients during March 2019 to June 2020, undergoing abdominal hysterectomy who were randomly divided into three groups including D (dexmedetomidine), K (ketamine) and B (bupivacaine). The study groups were compared in terms of hemodynamics, postoperative pain score and amount of drug used after 24 hours after surgery, as well as duration of postoperative analgesia. The obtained data were statistically analyzed using Spss 22 statistical software using ANOVA and T test. Results: The results of this study revealed the effect of intraperitoneal dexmedetomidine, bupivacaine and ketamine in controlling the pain following abdominal hysterectomy, among which intraperitoneal ketamine was more effective in controlling postoperative pain, increasing postoperative pain relief, and reducing postoperative opioid use when compared with dexmedetomidine and bupivacaine. Conclusion: All three drugs, intraperitonealdexmedetomidine, bupivacaine and ketamine, were detected to be essential in controlling postoperative pain in patients with complete abdominal hysterectomy. However, the effect of intraperitoneal ketamine was found to be greater than that of the other two drugs.