Details
Category: Volume 07 Issue 07 July 2019
Hits: 1357

Title: Comparison of different concentrations of epidural ropivacaine (0.05% 0.1% & 0.2%) for labour analgesia: A prospective randomized and double blind study

Authors: Dr Tushar Majumder, Dr Ranjit Reang, Dr H. Shanti Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.06

Abstract

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.

References

  1. Scott DB, Lee A, Fagan D. Acute toxicity of ropivacaine compared with that of bupivacaine. AnesthAnalg.1989;69:563–9.
  2. Zaric D, Nydahl PA, Adel SO. The effect of continuous epidural infusion of ropivacaine (0.1%, 0.2% and 0.3%) on nerve conduction velocity and postural control in volunteers. ActaAnaesthesiol Scand. 1996;40:342–9.
  3. Gautier P, De Kock M, Van Steenberge A. A double- blind comparison of 0.125% ropivacaine with sufentanil and 0.125% bupivacaine with sufentanil for epidural labor analgesia. Anesthesiology. 1999;90: 772–8.
  4. Polley LS, Columb MO, Wagner DS, Naughton NN. Dose dependent reduction of the minimum local analgesic concentration of bupivacaine by sufentanil for epidural analgesia in labor. Anesthesiology. 1998;89:626–32
  5. Fischer C, Blanie P, Jaouen E, et al. Ropivacaine, 0.1%, plus sufentanil, 0.5 microg/ml, versus bupivacaine, 0.1%, plussufentanil, 0.5 microg/ml, using patient-controlled epidural analgesia for labor: a double-blind comparison. Anesthesiology. 2000;92:1588–93.
  6. Fernandez-Guisasola J, Serrano ML, Cobo B. A comparison of 0.0625% bupivacaine with fentanyl and 0.1% ropivacaine with fentanyl for continuous epidural labor analgesia. AnesthAnalg. 2001;92:1261–5.
  7. Owen MD, Thomas JA, Smith T. Ropivacaine 0.075% and bupivacaine 0.075% with fentanyl 2 microg/mL are equivalent for labor epidural analgesia. AnesthAnalg. 2002;94:179–83.
  8. Palm S, Gertzen W, Ledowski T. Minimum local analgesic dose of plain ropivacaine vs. ropivacaine combined with sufentanil during epidural analgesia for
  9. David C. Campbell: Labour analgesia: what’s new and PCEA too? Can J Anaesth. 2003;50(6):R1-R7.
  10. Anim-Somuah M., Smyth R., Howell C: Epidural versus non epidural or no analgesia in labour, Cochrane Database Syst. Rev., CD000331, 2005.
  11. Scott DB, Lee A, Fagan D. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563- 9.
  12. Fischer C, Blanie P, Jaouen E. Ropivacaine, 0.1%, plus sufentanil, 0.5 mcg/mL, versus bupivacaine, 0.1%, plus sufentanil, 0.5 mcg/mL, using patient-controlled epidural analgesia for labor: a double-blind comparison. Anesthesiology. 2000;92:1588–93.
  13. Fernandez-Guisasola J, Serrano ML, Cobo B. A comparison of 0.0625% bupivacaine with fentanyl and 0.1% ropivacaine with fentanyl for continuous epidural labor analgesia. Anesth Analg. 2001;92:1261–5.
  14. David C. Campbell, MD, MSc, FRCPC, Rhonda M. Zwack, MD, Lesley-Ann L. Crone, MD. Ambulatory Labor Epidural Analgesia: Bupivacaine versus Ropivacaine 2000;90:1384 - 9.
  15. Emmanuel Boselli, MD, Richard Debon, MD, Fre´de´ricDuflo, MD, Boris Bryssine, MD. Ropivacaine 0.15% Plus Sufentanil 0.5 mcg/mL and Ropivacaine 0.10% plus Sufentanil 0.5 mcg/mL are equivalent for patient controlled Epidural Analgesia during labor. AnesthAnalg. 2003; 96:1173–7.
  16. WANG Li-zhong, CHANG Xiang-yang, LIU Xia, HU Xiao-xia, TANG Bei-lei. Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor: a randomized clinical trial. Chin Med J 2010;123(2):178-183.
  17. Dresner, J. Freeman, C. Calaw, A. Quinn. Ropivacaine 0.2% versus bupivaine 0.1% with fentanyl a double blind comparison for analgesia during labour. British Journal of Anaesthesia. 2000;85(6):826-9.
  18. Bee B. Lee, MBBS, Warwick D, NganKee. A Comparison of 0.0625% Bupivacaine with Fentanyl and 0.1% Ropivacaine with Fentanyl for Continuous Epidural Labor Analgesia. AnesthAnalg. 2004;98:1145–52.

Corresponding Author

Dr Tushar Majumder

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