Compare the efficacy of ropivacaine and bupivacaine with fentanyl for epidural labor analgesia

Abstract

INTRODUCTIONLabor, as the process of childbirth, is a painful experience for most of the women. The McGill pain questionnaire ranks pain in the upper part of pain scale between cancer and amputation of digit. Sir John Snow first administered chloroform to Queen Victoria for the birth of eighth Background: Attempts have been made to reduce or eliminate the pain associated with labor since ancient time. Obstetrics analgesia reached a new phase with lumbar epidural analgesia. We carried out a randomized study to evaluate and compare the analgesic efficacy of ropivacaine and bupivacaine with fentanyl on mother, on fetus and on the course of labor. Objectives: The aim of the present study was to evaluate and compare the analgesic efficacy of ropivacaine (0.125%) and bupivacaine (0.125%) with fentanyl on mother, fetus and on the course of labor, incidence of instrumental delivery, and the rate of cesarean section. Materials and Methods: Study was conducted in 60 term, primi or second gravida parturients with active phase of labor, with cervical dilatation 3-5 cm, with single fetus, vertex presentation belonging to American Society of Anesthesiology (ASA) Class I or II. The patients were randomly divided into two groups. After negative test dose, loading dose of 10 ml of 0.125% ropivacaine in Group R and 0.125% of bupivacaine in Group B with 2.5 µg/ml fentanyl in both groups was given as an initial dose for analgesia. Top up dose with 5 ml of 0.125% of ropivacaine in Group R and 0.125% bupivacaine in Group B were given when visual analog scale (VAS ≥3). For the second stage of labor 8 ml of 0.125% of ropivacaine in Group R and 0.125% of bupivacaine in Group B with 1.25 µg/ml fentanyl in both groups were given in sitting position to allow perineal analgesia. Results: In this study, we observed that maximum number of patients have developed sensory block up to T8, 50% in Group B and 53.3% in Group R, only 2 patients (6.7%) in Group B developed T6 level, and no patients in Group R. There was no significant difference in mean total dose of bupivacaine and ropivacaine (P > 0.05). In Group R total 22 patients and 3 in Group B developed Grade 0 motor blocked, which was statistically very significant. In Group B, 14 and 2 patients developed Grade 2 and Grade 3 motor blocked, respectively, compared to none of the patients in Group R which was statistically very significant. There was no significant difference in Apgar score and VAS scores between the groups at any time during the first and second stage of labor. Conclusions: Ropivacaine group patients required less number of top-up doses and developed significantly less motor block than bupivacaine group patients. We thus conclude that the combinations of 0.125% of ropivacaine with fentanyl and 0.125% bupivacaine with fentanyl is equally effective in producing excellent labor analgesia ensuring the safety of the mother and fetus.