Quality of labor epidural analgesia and maternal outcome with levobupivacaine and ropivacaine: A double-blinded randomized trial

Abstract

Background:Quality of labor analgesia plays a vital role in the maternal outcome. Very few literature are available analyzing the quality of epidural labor analgesia.Aim:The aim of this study was to compare the effectiveness of 0.1% levobupivacaine and 0.1% ropivacaine with fentanyl as an adjuvant for epidural labor analgesia in terms of onset, duration, quality of analgesia, and degree of motor blockade.Methodology:Sixty nulliparous parturients, with singleton uncomplicated pregnancy, were recruited by continuous sampling. Parturients were randomized to receive either levobupivacaine 0.1% or ropivacaine 0.1% with 2 μg/ml fentanyl as an intermittent epidural bolus. The epidural analgesia was initiated with 12 ml of study drug solution in the active stage of labor (cervix 3 cm dilated). Demand bolus was given whenever the visual analog scale (VAS) score >3. Onset, duration, and quality of analgesia and degree of motor blockade were analyzed. Maternal outcome was evaluated in terms of mode of delivery, duration of labor, and assisted vaginal delivery.Statistical Analysis:All the data were recorded in Microsoft Office Excel. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, USA) software with Regression Modules installed. Descriptive analyses were reported as mean and standard deviation of continuous variables.Results:The mean onset of analgesia was shorter in ropivacaine (21.43 ± 2 min) than in levobupivacaine group (23.57 ± 1.71 min) (P = 0.000). Duration of analgesia was shorter in ropivacaine (60 ± 14 min) than levobupivacaine (68 ± 11 min) (P = 0.027). Levobupivacaine produced a better quality of analgesia in terms of not perceiving pain and uterine contraction during labor analgesia but was associated with 37% incidence of instrumental delivery. Duration of labor and rate of cesarean section were comparable between the groups.Conclusion:Quality of analgesia in labor epidural was superior to levobupivacaine but was associated with higher incidence of instrumental vaginal delivery.

Equipotent dose of levobupivacaine reduce the incidence of instrumental vaginal delivery when compared to ropivacaine during epidural labour analgesia

“…In our study, we found that the mean onset of analgesia and the mean duration of analgesia was comparable between the two drugs but Kumar et al 5 found a statistically significant difference in the mean onset and mean duration of analgesia with 0.1% levobupivacaine and ropivacaine but did not find any clinical significance.…”

“…Purdie et al 17 compared 0.1% levobupivacaine and 0.1% ropivacaine with fentanyl by PCEA for labour analgesia and found 50% instrumental vaginal delivery with ropivacaine and 32% with levobupivacaine. Kumar et al 5 compared the same drug with same concentration by intermittent bolus technique and found similar 32% instrumental vaginal delivery with levobupivacaine but nil in ropivacaine group and they attributed the cause to be pelvic floor muscle laxity caused by more potent levobupivacaine than ropivacaine in equal concentrations. There is no literature available regarding 0.08% levobupivacaine with fentanyl for labour analgesia.…”

“…With the use of minimum local anaesthetic concentration (MLAC) and opioids as additives, many studies had proved that EA is not associated with increased caesarean section (CS) rate 1 but discussions regarding its influence on instrumental vaginal delivery (IVD) 2 and duration of labour 3 still persists thereby affecting the neonatal outcome. 4 Kumar et al 5 found that the incidence of IVD was 32% with 0.1% levobupivacaine and none with ropivacaine. Studies have been done with 0.0625% levobupivacaine for labour analgesia but found that frequent additional rescue drug was required to produce satisfactory analgesia.…”

Intrathecal Use of Isobaric Levobupivacaine 0.5% Versus Isobaric Ropivacaine 0.75% for Lower Abdominal and Lower Limb Surgeries

“…Although levobupivacaine and ropivacaine were introduced a few years ago, to our knowledge, there are very few studies on the use of isobaric levobupivacaine 0.5% and isobaric ropivacaine 0.75% for spinal anaesthesia for obstetric, abdominal and orthopaedic surgeries, and levobupivacaine has been found to be more potent [6][7][8][9][10][11][12][13][14]. Also, there have been very few studies among the Asian population [13,15]. Current literature on the use of these drugs focuses mostly on epidural and labour analgesia and peripheral nerve blocks [15][16][17][18].…”

“…Also, there have been very few studies among the Asian population [13,15]. Current literature on the use of these drugs focuses mostly on epidural and labour analgesia and peripheral nerve blocks [15][16][17][18].…”