Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis

Lv, Bao-sheng; Wang, Wei; Wang, Zhuo-Qiang; Wang, Xianwang; Wang, Jinghua; Fang, Fang; Mi, Weidong

doi:10.1185/03007995.2014.946127

Cited by 27 publications

(23 citation statements)

References 24 publications

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“…Notably, the incidence of pruritus was about 30% in each combination. In the meta-analysis of Lv et al, 10 the percent incidence of pruritus was also similar (BUPI-sufentanil 31% vs ROPI-sufentanil 35%). Similarly, the incidence of pruritus was observed as 36% in BUPI-FEN and 40% in BUPI-sufentanil groups in a meta-analytical review which attempted to study the efficacy and safety of these combinations.…”

Section: Discussionmentioning

confidence: 77%

“…It is postulated that ropivacaine possesses low lipophilic characteristics and therefore is resistant to rapidly penetrating the myelinated nerve fibers and thus is less likely to cause motor blockade and neurotoxicity. 30 However, in a meta-analysis, Lv et al 10 could not find a significant difference in the incidence of motor blocks between bupivacaine−sufentanil and ropivacaine−sufentanil combinations but noted a significantly higher incidence of instrumental deliveries in ropivacaine−sufentanil treated women ( P = 0.05), although, the percent incidence of motor blocks was slightly higher in bupivacaine−sufentanil treated women.…”

Section: Discussionmentioning

confidence: 93%

“… 9 Recently, the efficacy and safety of bupivacaine in combination with sufentanil have been reviewed against levobupivacaine and ropivacaine both in combination with sufentanil where it has been observed that the incidence of motor blocks was nonsignificantly higher in the bupivacaine–sufentanil combination. 10 So far, there is no systematic study to review the clinical trials that examined the efficacy and safety of these local amides in combination with fentanyl. Purpose of this meta-analysis is to compare the efficacy and safety of the combinational use of bupivacaine and fentanyl with ropivacaine and fentanyl in epidural analgesia for labor pain relief by analyzing data generated in the relevant randomized controlled trials (RCTs).…”

Section: Introductionmentioning

confidence: 99%

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Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor

Guo

Gao

et al. 2015

Medicine

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The aim of this study was to compare the efficacy and safety of the combinational use of bupivacaine and fentanyl versus ropivacaine and fentanyl in epidural analgesia for labor.Multiple electronic databases were searched by using appropriate MeSH terms, and keywords for original research papers published before October 2014. Meta-analyses were based on mean differences between the groups as well as odds ratios. Statistical heterogeneity was tested by I2 index.Fifteen randomized controlled trials, recruiting 2097 parturient mothers overall, were selected for the meta-analyses. Concentrations of the preparations used (weight/volume; mean and standard deviations) were bupivacaine 0.1023% ± 0.0375%, ropivacaine 0.1095% ± 0.042%, and fentanyl 0.00021% ± 0.000089%. There were no statistically significant differences between both the combinations in the mean change in Visual Analog Score for pain during labor, incidence of instrumental or cesarean delivery, neonate Apgar score of <7, maternal satisfaction, duration of either first or second stage of labor, oxytocin use for induction, onset of analgesia, and duration of analgesia. Women who received ropivacaine and fentanyl had significantly lower incidence of motor blocks (odds ratio [95% CI] = 0.38 [0.30, 0.48] P < 0.00001, fixed effect and 0.38 [0.27, 0.54] P < 0.0001, random effects I2 30%) when compared with women who received bupivacaine and fentanyl. Incidence of side effects was similar for both the combinations.Analgesia with ropivacaine in combination with fentanyl at 0.1%:0.0002% ratio for labor pain relief is associated with lower incidence of motor blocks in comparison with analgesia with bupivacaine and fentanyl at similar ratio (0.1%: 0.0002%).

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor

Guo

Gao

et al. 2015

Medicine

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“…The present meta-analysis has certain limitations. First, local anesthetics [ 35 ] and different doses of sufentanil may have affected the results. Because of the small size effect and limited number of included studies, we did not perform a further layer of analysis.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal Sufentanil Does Not Reduce Shivering During Neuraxial Anesthesia: A Meta-Analysis

et al. 2016

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BackgroundWe performed this meta-analysis to evaluate the efficacy of intrathecal sufentanil in preventing shivering during neuraxial anesthesia.Material/MethodsWe searched the Cochrane Library, PubMed, and Embase for all randomized controlled trials (RCT) on use of intrathecal sufentanil for preventing shivering during neuraxial anesthesia. References of retrieved articles were also screened. The quality of the studies was evaluated by the method recommended by the Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration’s RevMan 5.3 software. The primary outcome was incidence and severity of shivering, and the secondary outcomes were drug-related complications of pruritus, nausea, vomiting, hypotension, and bradycardia.ResultsEight original RCTs investigating a total of 1032 patients, of whom 599 received sufentanil and 473 received placebo, met the inclusion criteria. Compared to the placebo group, sufentanil did not reduce incidence of shivering (OR, 0.60; 95% CI, 0.35 to 1.01; P=0.06), but it increased the incidence of pruritus (OR, 12.52; 95% CI, 5.07 to 30.91; P<0.00001). Compared to the placebo group, sufentanil did not increase the incidence of nausea (OR, 0.69; 95% CI, 0.41 to 1.16; P=0.16), hypotension (OR, 0.93; 95% CI, 0.62 to 1.41; P=0.74), or bradycardia (OR, 0.86; 95% CI, 0.41 to 1.82; P=0.70). In addition, sufentanil reduced the incidence of vomiting during neuraxial anesthesia (OR, 0.45; 95% CI, 0.22 to 0.92; P=0.03).ConclusionsNeither epidural nor subarachnoid intrathecal sufentanil reduced shivering during neuraxial anesthesia, but it did increase the incidence of pruritus.

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“…Insgesamt scheint epidurales Ropivacain mit Sufentanil weniger bzw. geringer ausgeprägte motorische Blockaden zu verursachen als Bupivacain [18][19][20]. In der klinischen Praxis ergibt sich tatsächlich gehäuft die Situation, dass eine initial gut wirkende CSE gar nicht mehr epidural aufgespritzt werden muss, sondern nach 2-3 h in die vaginale Geburt mündet.…”

Section: Low-dose-mixtures In Der Forschungunclassified

Geburtshilfe: kombinierte Spinal-Epidural-Analgesie (CSE)

Wallenborn¹,

Artmann²,

Kranke³

2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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Due to intrathecal application, CSE combines rapid response with adequate analgesia with the possibility of providing unlimited neuraxial obstetrical pain relief via the indwelling epidural catheter. The superiority of CSE over EDA lies above all in its rapid action, excellent analgesia, lack of motor blockade after a single intrathecal opioid administration, lower rate of unilateral blockages and less need for subsequent epidural injections. The most common side effect is pruritus, which is harmless and usually does not require any therapeutic intervention. Even if no effect on rate of C-sections and APGAR values have been observed, the increased rate of fetal bradycardia after CSE must be kept in mind. A reduction of these fetal bradycardias and after intrathecal administration, prolongation of analgesia by means of appropriate drug combinations or additives should be the subject of future research.

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Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis

Cited by 27 publications

References 24 publications

Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor

Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor

Intrathecal Sufentanil Does Not Reduce Shivering During Neuraxial Anesthesia: A Meta-Analysis

Geburtshilfe: kombinierte Spinal-Epidural-Analgesie (CSE)

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