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Low dose intrathecal ropivacaine with or without sufentanil provides effective analgesia and does not impair motor strength during labour: a pilot study

[Une faible dose de ropivacaïne intrathécale, avec ou sans sufentanil, fournit une analgésie efficace et n'affecte pas la force motrice pendant le travail : une étude pilote]

Anil K. Soni, MD FRCA^*, Carolyn G. Miller, MD, Stephen D. Pratt, MD^*, Philip E. Hess, MD^*, Nancy E. Oriol, MD^* and Mukesh C. Sarna, MD FRCA^*

^* From the Harvard Medical School, Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts and the
Department Of Anesthesia and Critical Care, University of Washington Seattle, Washington, USA.

Address correspondence to: Dr. Anil K. Soni, Instructor at Harvard Medical School, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston, MA 02215, USA. Phone: 617-667-3112; Fax: 617-667-7849; E-mail: aksoni{at}mediaone.net

Purpose: Although ropivacaine has been used to provide spinal anesthesia in the surgical population, its intrathecal administration for labour analgesia has only recently been described. We evaluated the effects of low dose intrathecal ropivacaine with or without sufentanil for labour analgesia.

Methods: Thirty-six term parturients in active labour were randomly assigned to receive 3 mg of intrathecal ropivacaine (group R) or 3 mg ropivacaine with 10 µg of sufentanil (group RS). Patients were evaluated by a blinded observer for hypotension, linear analogue score (VAS 0–100) for labour pain, motor power in the lower limbs, onset of analgesia, sensation to cold and pin prick, duration of analgesia, and neonatal Apgar scores. The following day patients were assessed for satisfaction, headache and neurologic deficit.

Results: The mean duration of analgesia in the R group was 41.4 ± 4.9 min and 95.0 ± 6.1 min in the RS group (mean ± SEM, P=0.0001). All subjects had satisfactory analgesia at five minutes, although analgesia from the ropivacaine- sufentanil combination was superior to that provided by ropivacaine alone. Total duration of labour was no different between the groups (R- 306 ± 34, RS- 384 ± 44 min, P=0.17). No patient showed evidence of motor block. All patients were satisfied with the labour analgesia. No neurological complications were observed.

Conclusions: Low dose ropivacaine provides effective analgesia during labour via the intrathecal route. It can be mixed with sufentanil in the above-mentioned concentrations to improve both the quality and duration of analgesia. Fetal outcome remains favourable. It may provide minimal or no motor block, to facilitate ambulation.

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