Introduction:  Epidural infusion of 0.2% ropivacaine is recommended by the manufacturer  for labour analgesia,  but  lower concentrations may be effective. The present work is a clinical comparative study of different doses of ropivacaine i.e. 0.05%, 0.1% and 0.2%, each with 2 mcg/mL of fentanyl to find out minimum effective concentration of ropivacaine that can be used safely in epidural labor analgesia.

Materials and Methods: The study was conducted on sixty (60) parturient of ASA grade I and grade II physical status, in labor, with single fetus, vertex position, between 37-42 weeks gestation with regular contractions (true labor pain) with 4-6 cm cervix dilatation  and  who  had  requested  labor  analgesia.  Parturients  were  then  allocated  randomly  to  one  of  three  groups  with  20parturients in each group. Group 1 received 0.05% ropivacaine with 2 mcg/mL fentanyl, Group 2 received 0.1% ropivacaine with2 mcg/mL fentanyl and Group 3 received 0.2% ropivacaine  with  2  mcg/mL  fentanyl.  After  completion  of  the study, the nonparametric data of the study was analyzed with Kruskal  Wallis  test  and  parametric data of the study was analyzed with ANOVA test and p value of <0.05 was taken as statistically significant.

Results: Patient demographics and labor characteristics were comparable in all the groups. Ropivacaine 0.05% with 2 mcg/mL of fentanyl produced adequate analgesia for labor and delivery in  only 50% of  parturient  while ropivacaine 0.1% &ropivacaine0.2% with 2 mcg/mL of fentanyl produced adequate analgesia in 90% of parturient in group II and group III. Reduction in local anesthetic was not associated with any change in incidence of motor block or instrumental deliveries.

Conclusion: We concluded that the minimum concentration which can be used safely for labor analgesia with no adverse effect is 0.1% of ropivacaine with 2 mcg/mL fentanyl.

Keywords: epidural labour analgesia, Ropivacine, fentanyl.

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Dr Tushar Majumder

Senior Resident, Dept. of Anesthesiology, AGMC and GBP hospital, Agartala