Comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labour

ABSTRACT

Fifty labouring women were randomized to receive either 0.125% ropivacaine with fentanyl 2 ug/ml or an equivalent concentration of bupivacaine / fentanyl using patient controlled epidural analgesia [PCEA] with settings of6ml/h basal rate , 5ml bolus, lO.rnin lockout, 30ml/h dose limit.Analgesia, local anaesthetic use, motor block, patient satisfaction and side effects were assessed until the time of delivery. No differences in verbal pain scores, local anesthetic use , patient satisfaction or side effects between groups were observed. Hourly local anesthetic use was similar and did not differ between groups . the mean total volume of ropivacaine /fentanyl administered from epidural catheter placement until delivery was 85.3 +/- 30.6ml ropivacaine and 170.6 +/- 61.2 ug . fentanyl versus 88.2 +/- 25.2ml bupivacaine. and 176.4 +/- 50.4 ug fentanyl PCEA demands and delivered doses were similar between groups however patients administered ropivacaine / fentanyl developed significantly less motor block than an equivalent concentration of bupivacaine / fentanyl.. this statistical significant reduction in motor block decreased the incidence of instrumental delivery in ropivacaine/fentanyl group . Neonatal assessment included APGAR scores umbilical cord blood gas analysis and neurobehavioral testing at delivery,2 and 24h of life using the neurologic and adaptive capacity score [NACS] were reported . Neonatal condition was good and generally similar in all groups. In summary, by using a patient controlled epidural analgesia technique, ropivacaine 0.125% with fentanyl 2ug/ml produces similar analgesia with significantly less motor block than similar concentration of bupivacaine with fentanyl during labour without detrimental effects to the foetus