0.125% Ropivacaine Is Similar to 0.125% Bupivacaine for Labor Analgesia Using Patient-Controlled Epidural Infusion

Owen, Medge D.; D’Angelo, Robert; Gerancher, J. C.; Thompson, John M.; Foss, Michael L.; Babb, Jeffrey D.; Eisenach, James C.

doi:10.1213/00000539-199803000-00015

Cited by 120 publications

(48 citation statements)

References 16 publications

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“…Jaime Fernandez-Guisasola et al shows upper level of sensory block in most of the parturient as T8 (T7-T9). 12 This was comparable to the level achieved by Owen et al 14 This concurs with the studies of Bleyaert et al and James et al who have used 0.125% and 0.1% bupivacaine respectively in their studies.…”

Section: Level Of Sensory Blockadesupporting

confidence: 88%

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A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

Kanna¹,

Hakkim²,

Murugadoss³

et al. 2015

Int J Res Med Sci

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INTRODUCTIONPain in labour is an extremely agonising experience for most women. Various methods have been tried since time immemorial to alleviate this pain. However, this endeavor did not receive much support till the late 19th century, with analgesia for labour being opposed for both medical and religious reasons. It was also believed that ABSTRACT Background: Pain in labour is an extremely agonising experience for most women. Unrelieved labour pain produces many physiological changes which are detrimental to both the mother and the foetus. Various methods have been used to alleviate this pain. It is now well recognized that the only consistently effective method of pain in labour is lumbar epidural analgesia. Using a higher concentration of local anaesthetic agent to produce analgesia can be associated with undesirable side effects such as motor block, haemodynamic disturbances or interference with the progress of labour. Hence, various adjutants like adrenaline, clonidine and particularly opioids have been used to reduce the amount of local anaesthetics used and yet provide satisfactory analgesia. In view of the above, the present study assesses the clinical effectiveness of continuous lumbar epidural analgesia for vaginal delivery by using 0.0625% bupivacaine with 2µg/ml of fentanyl. Methods: Forty parturient admitted to Chennai Medical College and Hospital, Trichy, for vaginal delivery and who were in active labor was given 8 ml of 0.0625% bupivacaine with 2µg/ml of fentanyl. The parturient were assessed with respect to onset and duration of analgesia, maximum level of analgesia, pain scores, homodynamic parameters, motor block, side effects, mode of delivery and neonatal outcome. Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes). A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 µg of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate.

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Section: Level Of Sensory Blockadesupporting

confidence: 88%

“…Cohen et al found hypotension in 5-11% of patients receiving fentanyl along with bupivacaine. 7,12,14,15,18 There was no incidence of bradycardia in the present study. The maternal heart rate ranged from 79±12 to 98±13 beats per minute as observed by Finegold et al…”

Section: Cardiovascular Status Assessmentcontrasting

confidence: 38%

A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

Kanna¹,

Hakkim²,

Murugadoss³

et al. 2015

Int J Res Med Sci

View full text Add to dashboard Cite

show abstract

“…However, in this study, intermittent injection rather than infusions were used for analgesia and the bupivacaine group needed more top-up injections than did the ropivacaine group. Both these studies showed 13,14 that ropivacaine, despite its lower potency, provided similar degree of analgesia as bupivacaine at comparable concentration.…”

Section: Discussionmentioning

confidence: 93%

Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125% — fentanyl infusions for epidural labour analgesia

Finegold

Mandell

Ramanathan

2000

Can J Anesth/J Can Anesth

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Purpose: To compare analgesic efficacies of ropivacaine-fentanyl and bupivacaine-fentanyl infusions for labour epidural analgesia. Methods:In this double-blind, randomized study 100, term, nulliparous women were enrolled. Lumbar epidural analgesia (LEA) was started at cervical dilatation < 5 cm using either bupivacaine 0.25% followed by bupivacaine 0.125% + 2 µg·ml -1 fentanyl infusion (n=50) or ropivacaine 0.2% followed by ropivacaine 0 .1% + 2 µg·ml -1 fentanyl infusion (n=50). Every hour maternal vital signs, visual analog scale (VAS) pain score, sensory levels, and motor block (Bromage score) were assessed. Data were expressed as mean ± 1 SD and analyzed using Chi -Squared and Mann-Whitney U tests at < 0.05. Results:The onset times were 10.62 ± 4.9 and 11.3 ± 4.7 min for the bupivacaine and ropivacaine groups respectively (P = NS). The median VAS scores were not different between the groups at any of the evaluation periods. However, at least 80% of patients in the ropivacaine group had no demonstrable motor block after the first hour compared with only 55% of patients given bupivacaine (P =0.01).Conclusions: Both bupivacaine and ropivacaine produce satisfactory labour analgesia. However, ropivacaine infusion is associated with less motor block throughout the first stage of labour and at 10 cm dilatation.Objectif : Comparer l'efficacité analgésique des perfusions de ropivacaïne-fentanyl et de bupivacaïne-fentanyl pour l'analgésie péridurale pendant le travail obstétrical.Méthode : Cent femmes nullipares et à terme ont été recrutées pour participer à une étude randomisée et à double insu. L'analgésie péridurale lombaire (APL) a été amorcée quand la dilatation cervicale était < 5 cm en utilisant soit de la bupivacaïne à 0,25 % suivie de bupivacaïne à 0,125 % + une perfusion à 2 µg·ml-1 de fentanyl (n=50), soit de la ropivacaïne à 0,2 % suivie de ropivacaïne à 0,1 % + une perfusion à 2 µg·ml-1 de fentanyl (n=50). On a noté à toutes les heures : les signes vitaux de la mère, les scores de douleur à l'échelle visuelle analogique (EVA), les niveaux sensitifs et le bloc moteur (score de Bromage). Les données ont été exprimées en termes de moyenne ± un écart type et analysées d'après le test Chi 2 et le test U de Mann-Whitney à <0,05.Résultats : Les délais d'installation ont été de 10,62 ± 4,9 et de 11,3 ± 4,7 min pour la bupivacaïne et la ropivacaïne respectivement (P = NS). Les scores moyens de l'EVA n'ont pas affiché de différence intergroupe. Cependant, au moins 80 % des patientes qui ont reçu de la ropivacaïne n'avait pas de bloc moteur vérifiable après la première heure contrairement à 55 % seulement des patientes à qui on a donné de la bupivacaïne (P =0,01).Conclusion : La bupivacaïne et la ropivacaïne produisent une analgésie satisfaisante pendant le travail obstétrical. La perfusion de ropivacaïne est toutefois associée à un bloc moteur moins intense pendant la première phase du travail et à 10 cm de dilatation.

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“…Various studies reported similar pattern of sensory and motor blockades with ropivacaine and bupivacaine at a dose ratio of approximately 1.5 to 1, 1 0 suggesting that this was the equipotent dose ratio. Polley and colleagues 1 1 estimated the relative potencies of epidural ropivacaine and bupivacaine for labor analgesia by using an up-down sequential allocation study design, and demonstrated a potency ratio ranging between 1.35 to 1 and 2 to 1; while D'Angelo and colleagues [12][13][14] reported a similar potency ratio between epidural ropivacaine and bupivacaine during labor analgesia when used with or without the addition of low doses fentanyl. According to the results of this study, the dose ratio between ropivacaine and bupivacaine allowing for similar thoracic epidural analgesia after major abdominal surgery when added to 2 µg·ml -1 epidural fentanyl is nearly 1.3 to 1.…”

Section: Discussionmentioning

confidence: 99%

Patient supplemented epidural analgesia after major abdominal surgery with bupivacaine/fentanyl or ropivacaine/fentanyl

Berti

Fanelli

Casati

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To compare analgesic efficacy and occurrence of motor block and other side effects during patient supplemented epidural analgesia (PSEA) with either ropivacaine/fentanyl or bupivacaine/fentanyl mixtures. Methods:In a prospective, randomized, double-blind study, 32 ASA I-III patients undergoing major abdominal surgery received an epidural catheter at the T 8 -T 10 , followed by integrated general epidural anesthesia. Postoperative epidural analgesia was provided using a patient controlled pump with either ropivacaine 0.2%/2 µg·ml -1 fentanyl (group Ropivacaine, n = 16) or bupivacaine 0.125%/2 µg·ml -1 fentanyl (group Bupivacaine, n = 16) [background infusion 4 -6 ml·hr -1 , 1.5 ml Incremental Doses and 20 min lock out]. Verbal pain rating score, number of incremental doses, consumption of epidural analgesic solution and rescue analgesics, sedation (four-point scale), and pulse oximetry were recorded by a blind observer for 48 hr after surgery. Conclusion: Using a ropivacaine 0.2% / 2 µg·ml -1 fentanyl mixture for patient supplemented epidural analgesia after major abdominal surgery provided similar successful pain relief as bupivacaine 0.125%/2 µg·ml -1 fentanyl, but patients receiving bupivacaine/fentanyl requested more supplemental.Objectif : Comparer l'efficacité analgésique, l'occurrence de blocage moteur et autres effets secondaires pendant une analgésie épidurale complétée (AEC) avec un mélange de ropivacaïne/fentanyl ou de bupivacaïne/fentanyl.Méthode : L'étude prospective, randomisée et à double insu a porté sur 32 patients d'état physique ASA I-III qui devaient subir une intervention chirurgicale abdominale majeure. Un cathéter épidural a été mis en place à T 8 -T 10 et une anesthésie générale/péridurale intégrée a suivi. L'analgésie épidurale postopératoire, administrée par une pompe contrôlée par le patient, comprenait soit un mélange de ropivacaïne à 0,2 %/2 µg·ml -1 de fentanyl (groupe Ropivacaïne, n = 16) soit un mélange de bupivacaïne à 0,125 %/2 µg·ml -1 de fentanyl (groupe Bupivacaïne, n = 16) [perfusion de base de 4-6 ml·h -1 , doses en incréments de 1,5 ml et période réfractaire de 20 min]. Le score verbal d'estimation de la douleur, le nombre de doses incrémentielles, la consommation d'analgésique épidural et de doses d'appoint, la sédation (selon une échelle en quatre points) et l'oxymétrie de pouls ont été enregistrés par un observateur impartial pendant 48 h après l'opération.Résultats : Aucune différence intergroupe n'a été observée quant au soulagement de la douleur, au blocage moteur, au degré de sédation, à l'oxymétrie de pouls et aux autres effets secondaires. Conclusion : Un mélange de ropivacaïne à 0,2 %/2 µg·ml -1 de fentanyl, comme analgésie épidurale d'appoint à la suite d'une intervention chirurgicale abdominale majeure, a fourni un soulagement de la douleur d'efficacité similaire à un mélange de bupivacaïne à 0,125 %/2 µg·ml -1 de fentanyl, mais ce dernier a nécessité plus de doses d'appoint.Patient supplemented epidural analgesia after major abdominal surgery with bupi...

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0.125% Ropivacaine Is Similar to 0.125% Bupivacaine for Labor Analgesia Using Patient-Controlled Epidural Infusion

Cited by 120 publications

References 16 publications

A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125% — fentanyl infusions for epidural labour analgesia

Patient supplemented epidural analgesia after major abdominal surgery with bupivacaine/fentanyl or ropivacaine/fentanyl

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