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Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125% - fentanyl infusions for epidural labour analgesia

From the Department of Anesthesiology and Critical Care Medicine, The University of Pittsburgh School Of Medicine, Magee–Women's Hospital, 300 Halket Street, Pittsburgh, Pennsylvania 15213, USA.

Address correspondence to: Dr. H. Finegold. Phone: 412-641-4260; Fax: 412-641-4766; E-mail: Finegold{at}anes.upmc.edu

Purpose: To compare analgesic efficacies of ropivacaine-fentanyl and bupivacaine-fentanyl infusions for labour epidural analgesia.

Methods: In this double-blind, randomized study 100, term, nulliparous women were enrolled. Lumbar epidural analgesia (LEA) was started at cervical dilatation < 5 cm using either bupivacaine 0.25% followed by bupivacaine 0.125% + 2 µg•ml^–1 fentanyl infusion (n=50) or ropivacaine 0.2% followed by ropivacaine 0 .1% + 2 µg•ml^–1 fentanyl infusion (n=50). Every hour maternal vital signs, visual analog scale (VAS) pain score, sensory levels, and motor block (Bromage score) were assessed. Data were expressed as mean ± 1 SD and analyzed using Chi -Squared and Mann-Whitney U tests at < 0.05.

Results: The onset times were 10.62 ± 4.9 and 11.3 ± 4.7 min for the bupivacaine and ropivacaine groups respectively (P = NS). The median VAS scores were not different between the groups at any of the evaluation periods. However, at least 80% of patients in the ropivacaine group had no demonstrable motor block after the first hour compared with only 55% of patients given bupivacaine (P =0.01).

Conclusions: Both bupivacaine and ropivacaine produce satisfactory labour analgesia. However, ropivacaine infusion is associated with less motor block throughout the first stage of labour and at 10 cm dilatation.

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