Title: Comparative Study of 0.1% Bupivacaine with Fentanyl versus 0.1% Ropivacaine with Fentanyl for Epidural Labour Analgesia
Authors: Dr Kumar Gourav, Dr Praveen Kumar Tiwari, Dr (Prof) Usha Suwalka
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.88
Abstract
Background: Analgesia during labour provides painless delivery and reduces the stress response due to labour pain. Bupivacaine is commonly used local anaesthetic for labour analgesia, but it can produce motor blockade, ropivacaine provides ambulatory analgesia, opioids added to the local anaesthetic provides increased duration of analgesia, enhanced intensity of analgesia and decreases the dose of local anaesthetic.
Method: After approval from ethical committee at RIMS 60 ASA grade I/II primi parturients with singleton pregnancy, term gestation, cephalic presentation, in active first stage of labour, aged 18-35 years were included in the study. Patients were randomly allocated into two groups Group B (n = 30) & Group R (n = 30). Epidural technique was standardised and efficacy was compared between the groups.
Results: Bupivacaine and Ropivacaine provide equivalent labour analgesia. Motor blockade produced was minimal with ropivacaine when compared to bupivacaine.
Keywords: Epidural analgesia, Bupivacaine, Ropivacaine, Fentanyl.
References
- Lowe NK. The nature of labor pain. Am J Obstet. 2002;186:16–24.
- American College of Obstetricians and Gynecologists. Dystocia and augmentation of labor. ACOG Practice Bulletin No.49. Obstetrics and Gynecology. 2003;102:1445–1454.
- Melzack R. The myth of painless childbirth. 1984;19:321–37.
- Cardin H, Moisson Tardieu MT, Tournaire M. La péridurale.Paris: Balland; 1986.
- Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. 1979;51:285–287.
- Halpern SH, Breen TW, Campbell DC, et al. A multicenter, randomized, controlled trial comparing bupivacaine with ropivacaine for labor analgesia. 2003;98:1431–1435.
- Gündüz Ş, Eriş Yalçın S, Karakoç G, Akkurt MÖ, Yalçın Y, Yavuz A. Comparison of bupivacaine and ropivacaine in combination with fentanyl used for walking epidural anesthesia in labor. Turk J Obstet Gynecol. 2017;14(3):170–175.
- Lee BB, Ngan Kee WD, Ng FF, Lau TK, Wong EL. Epidural infusions of ropivacaine and bupivacaine for labor analgesia: A randomized, double-blind study of obstetric outcome. Anesth Analg 2004;98:1145-52
- Stienstra R, Jonker TA, Bourdrez P, Kuijpers JC, van Kleef JW, Lundberg U. Ropivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labor: A double-blind comparison. Anesth Analg 1995;80:285-9.
- Owen MD, D′Angelo R, Gerancher JC, Thompson JM, Foss ML, Babb JD, et al.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patient-controlled epidural infusion. Anesth Analg 1998;86:527-31.
- McCrae AF, Westerling P, McClure JH. Pharmacokinetic and clinical study of ropivacaine and bupivacaine in women receiving extradural analgesia in labour. Br J Anaesth 1997;79:558-62
- Eddleston JM, Holland JJ, Griffin RP, Corbett A, Horsman EL, Reynolds F. A double-blind comparison of 0.25% ropivacaine and 0.25% bupivacaine for extradural analgesia in labour. Br J Anaesth 1996;76:66-71
- Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: A meta-analysis. Anesth Analg 2003; 96:1473-9
- Writer WD, Stienstra R, Eddleston JM, Gatt SP, Griffin R, Gutsche BB, et al.Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: A prospective meta-analysis. Br J Anaesth 1998;81:713-7.
- Owen MD, Thomas JA, Smith T, Harris LC, D′Angelo R. Ropivacaine 0.075% and bupivacaine 0.075% with fentanyl 2 microg/mL are equivalent for labor epidural analgesia. Anesth Analg 2002;94:179-83.
- Campbell DC, Zwack RM, Crone LA, Yip RW. Ambulatory labor epidural analgesia: Bupivacaine versus ropivacaine. Anesth Analg 2000;90:1384-9.
- Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: Implications for therapeutic indexes. Anesthesiology 1999;90:944-50.
- Capogna G, Celleno D, Fusco P, Lyons G, Columb M. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Br J Anaesth 1999;82:371-3.
- McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: A comparison to bupivacaine in volunteers. Anesthesiology 1999; 90:971-7.
- Fettes PD, Moore CS, Whiteside JB, McLeod GA, Wildsmith JA. Intermittent vs continuous administration of epidural ropivacaine with fentanyl for analgesia during labour. Br J Anaesth 2006;97:359-64.