Ropivacaine 0.25% Versus Bupivacaine 0.25% for Continuous Epidural Analgesia in Labor

Abstract

We compared the effects of continuous epidural infusion of ropivacaine 0.25% with bupivacaine 0.25% on pain relief and motor block during labor, and on the neonate. Seventy-six full-term parturients in active labor requiring epidural analgesia were randomly allocated to receive either bupivacaine 0.25% or ropivacaine 0.25%. Fifteen minutes after a loading dose of 10 mL of the study drug, an epidural infusion with the same drug was started at 6-12 mL/h to maintain an adequate block. Top-up doses of 6-10 mL were given as required. At full cervical dilation, the epidural infusion was discontinued. The onset of pain relief (verbal scale), contraction pain (visual analog scale), intensity of motor block (modified Bromage scale), and duration of motor block were not statistically different between the groups. Apgar scores at 1 and 5 min after delivery were comparable. There was a higher proportion of the neonates in the ropivacaine group (26/31 = 84%) who had a neurologic and adaptive capacity score (NACS) > or = 35 2 h after delivery than in the bupivacaine group (18/29 = 62%). We conclude that ropivacaine 0.25% and bupivacaine 0.25% are equally effective for epidural pain relief during labor. Ropivacaine may have an advantage over bupivacaine regarding neonatal neurobehavioral performance during the first few hours after delivery, although further studies will be required to substantiate this.

Onset of labor epidural analgesia with ropivacaine and a varying dose of fentanyl: a randomized controlled trial

“…7 Pain relief was graded as a four-point verbal scale in other studies that reported that the onset of epidural analgesia from bupivacaine or ropivacaine was approximately 10-15 min with or without opioid. 9,18 In our study, we defined the onset of epidural analgesia as the time from epidural injection to a VAS pain score of <30 mm, because a VAS score < 20-30/100 is usually considered as successful analgesia. 19,20 We are unaware of other studies that have measured the onset of epidural labor analgesia using ropivacaine with a varying dose of fentanyl.…”

Comparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia

“…Some investigators have compared ropivacaine 0.25% with bupivacaine 0.25% and found no significant differences in the quality of analgesia, sensory block or motor block. 11,12 Owen et al 7 compared ropivacaine 0.125% plus fentanyl 2 lg/mL with bupivacaine 0.125% plus fentanyl 2 lg/mL using PCEA. They did not find any difference between the two drugs.…”

Parturient‐controlled epidural analgesia during labour: bupivacaine vs. ropivacaine

“…Ropivacaine, an amide local anaesthetic, has gained much popularity as an agent for obstetric epidural analgesia because of a reduced propensity for causing cardiotoxicty and a purportedly greater selectivity for sensory fibres compared with bupivacaine [1–3]. However, the expected advantage of reduced motor block was not evident in earlier studies comparing ropivacaine with bupivacaine for labour epidural analgesia administered by intermittent top‐ups, continuous infusion or continuous infusion with patient‐controlled top‐ups [4–6]. Furthermore, recent studies have suggested that epidurally administered ropivacaine is 40% less potent than bupivacaine based on the index of the ‘50% effective dose’ (ED 50 ) [7, 8].…”