Comparison Between the Use of Ropivacaine Alone and Ropivacaine With Sufentanil in Epidural Labor Analgesia

Abstract

To compare the analgesic efficacy and safety of the sole local anesthetic ropivacaine with the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil given epidurally on the labor pain control.After institutional review board approval and patient consent, a total of 500 nulliparas requesting epidural labor analgesia were enrolled and 481 eventually were randomized into 2 groups: a sole local anesthetic group (ropivacaine 0.125%) and a combination of local anesthetic and opioidergic analgesic group (0.125% ropivacaine + 0.3 μg/mL sufentanil). After the test dose, a 10-mL epidural analgesic solution was given in a single bolus, followed by intermittent bolus injection of 10 to 15 mL of the solution. The primary outcome was the analgesic efficacy measured using Numerical Rating Scale (NRS) of pain. Other maternal and infant variables were evaluated as secondary outcomes.A total of 346 participants completed the study. The median NRS pain score during the 1st stage of labor was significantly lower in the combination group 2.2 (interquartile range [IQR]: 1.8–2.7) comparing to the sole local analgesic group 2.4 (IQR: 2.0–2.8) (P < 0.0001). No significant difference was observed in NRS pain score prior epidural analgesia and during the 2nd stage of labor. Patients in both groups rated same satisfaction of analgesia. Patients in the sole local analgesic group experienced fewer side effects than those in the combination group (37.7% vs 47.2%, P = 0.082). The individual analgesia-related cost in the sole local analgesic group was less ($5.7 ± 2.06) than that in the combination group ($9.76 ± 3.54) (P < 0.0001). The incidence of 1-minute Apgar ≤ 7 was lower in the sole local analgesic group 2 (1.2%) than the combination group 10 (5.5%) (P = 0.038). No difference was found between other secondary outcomes.The sole local anesthetic ropivacaine produces a comparable labor analgesic effect as the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil at different stages of labor (ΔNRS = 0.2) but the former has less side effects, lower cost, and less incidence of lower 1-minute Apgar scoring. These results imply the necessity of a systematic reevaluation of epidural labor analgesia with sole local anesthetics against combination regimens of local anesthetics and other opioids.

Epidural Dexmedetomidine for Prevention of Intrapartum Fever During Labor Analgesia: A Randomized Controlled Trial

“…Local anesthetics combined with other analgesics can improve analgesic effects and reduce adverse events [23][24][25]. In our study, the incidence of hypotension, bradycardia, respiratory depression, excessive sedation, motor block nausea and vomiting was similar between Fig.…”

Midazolam and ropivacaine act synergistically to inhibit bone cancer pain with different mechanisms in rats

“…Based on the following evidence, we suggested thay combination of MZL&Ropi might induce synergistic analgesia. First, Ropi as a block of fast voltage-gated sodium channels on neuronal axons is used as analgesia for many kinds of pain in basic experiments (13,14) and clinical trials (15,16). In our previous study, Ropi c alleviated CFA-induced chronic inflammatory pain in rats, and combination with Ropi and Dex showed synergistic analgesia on the chronic inflammatory pain (14).…”

By regulating miR-182-5p/<i>BCL10</i>/<i>CYCS</i>, sufentanil reduces the apoptosis of umbilical cord mesenchymal stem cells caused by ropivacaine

“…Sufentanil is a strong opioid analgesic that is quick-acting, it has a short half-life of elimination, and it has little effect on hemodynamics (7). A combination of ropivacaine and sufentanil is a highly effective form of labor analgesia that can effectively relieve pain, shorten the course of labor, reduce postpartum hemorrhage, and reduce the need to perform a cesarean section (8). However, whether these drugs have an adverse effect on newborn's prognosis is not known.…”