Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

Abstract

The present study aimed to investigate and compare the analgesic effect and safety of ropivacaine or levobupivacaine in combined spinal-epidural anesthesia during childbirth and their effects on neonatal Apgar scores, as well as maternal and neonatal vital signs. A total of 615 maternal patients undergoing labor between April 2016 and March 2017 were divided into two groups according to the analgesic used for combined spinal-epidural anesthesia during childbirth: The ropivacaine group (n=318) and the levobupivacaine group (n=297). The onset time of analgesia in the two groups was determined and the pain score on the visual analog scale was assessed at the time of delivery (T3). At pre-analgesia, 30 min after analgesia (T2), at T3 and during maternal wound suturing (T4), the systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were assessed. The cesarean section rate, neonatal 1-and 5-min Apgar scores and neonatal asphyxia at T4 were also determined. The onset time of analgesia in the ropivacaine group was significantly reduced compared with that in the levobupivacaine group (P<0.05). At T2 and T4, the SBP was significantly higher in the levobupivacaine group than that in the ropivacaine group (P<0.05). At T2, T3 and T4, the DBP was significantly lower in the levobupivacaine group compared with those in the ropivacaine group (P<0.05). At T2, the HR was significantly lower in the levobupivacaine group than that in the ropivacaine group (P<0.05). The cesarean section rate was significantly lower in the ropivacaine group compared with that in the levobupivacaine group [4.09% (n=13) vs. 22.89% (n=68); P<0.01]. In conclusion, the use of combined spinal-epidural anesthesia with ropivacaine or levobupivacaine has an excellent analgesic effect during childbirth. However, compared with levobupivacaine, ropivacaine for labor analgesia had a faster onset and a lesser impact on maternal vital signs, and was associated with a reduced maternal cesarean section rate among patients who did not opt for cesarean section in the beginning; therefore, it is useful in clinical practice.

Comparing the effects of ropivacaine and lidocaine associated with epinephrine on the heart rate, blood pressure, and amount of bleeding in patients candidate for cleft palate repair: A randomized clinical trial

“…However, ropivacaine had a faster onset and less effect on maternal vital signs for anesthesia in delivery compared to levobupivacaine and was associated with a decrease in maternal the cesarean section rate among patients who did not initially choose a cesarean section. Therefore, it is useful in clinical practice (23). Evaluating ropivacaine and bupivacaine in cesarean section anesthesia, it was observed that ropivacaine had a little effect on hemodynamic indices (including blood pressure and heart rate) with a decreasing effect on the duration of sensory and motor block.…”

Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study

“…Ropivacaine is believed to exert selective effects on sensory fibers, has a stronger ability to inhibit nerve conduction in pain-sensitive fibers, and exhibits less mobility reduction [28,29]. Levobupivacaine is a bupivacaine S(−) isomer that has an onset and duration of action similar to bupivacaine, but with fewer toxic effects on the cardiovascular and central nervous systems [30,31].…”

“…Levobupivacaine is a bupivacaine S(−) isomer that has an onset and duration of action similar to bupivacaine, but with fewer toxic effects on the cardiovascular and central nervous systems [30,31]. Although levobupivacaine may have a slower onset, it exerts higher motor block than ropivacaine [29]. The combination of local anesthetics may influence the painrelieving effect or morphine and, thus, indirectly moderated the occurrence of pruritus.…”

A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis

“…Cesarean section is one of the most common surgeries in obstetrics, the rate of which is increasing significantly worldwide (1)(2)(3)(4). The rate of cesarean section has been reported at 42.35% in the world and 47.9% in Iran (5,6). The correct management of delivery and choosing the appropriate anesthetic method to achieve analgesia and maintain the health of the mother and fetus during cesarean section are of great importance (7).…”