Comparison of patient-controlled epidural bolus administration of 0.1% ropivacaine and 0.1% levobupivacaine, both with 0.0002% fentanyl, for analgesia during labour.

The aim of the study was to compare the relative potencies and clinical characteristics of epidural ropivacaine and levobupivacaine in labour using patient-controlled epidural analgesia (PCEA). In a randomised double-blinded study, 60 ASA I or II primigravidae requesting epidural analgesia in early labour were allocated to receive either 0.1% ropivacaine with fentanyl 0.0002% or 0.1% levobupivacaine with 0.0002% fentanyl via a patient-controlled analgesia pump. Analgesia was established with 15 ml of study solution and maintained using 5-ml boluses of study solution with a 5-min lockout interval. There were no significant differences in onset time, duration and quality of analgesia, motor and sensory blockade, local anaesthetic consumption, mode of delivery, neonatal outcome or maternal satisfaction between the groups. We conclude that 0.1% ropivacaine with 0.0002% fentanyl and 0.1% levobupivacaine with 0.0002% fentanyl are clinically indistinguishable for labour analgesia and appear pharmacologically equipotent when using PCEA.

Patient controlled administration of intravenous alfentanil during elective caesarean section under subarachnoid anaesthesia.

In this observational study, an alfentanil-containing patient controlled analgesia device was evaluated for the relief of visceral pain during elective caesarean section under subarachnoid anaesthesia. Forty healthy women at term received 2.5 mL of intrathecal hyperbaric 0.5% bupivacaine in the sitting position. Surgery began when loss of cold appreciation to the fourth thoracic dermatome was demonstrated. The patient controlled analgesia device was configured to deliver 3 microg.kg(-1) of alfentanil when first actuated. Each subsequent demand delivered 1.5 microg.kg(-1) with a 2-min lock-out interval. Sixty-five percent of women used alfentanil during surgery. The median (IQR) consumption of alfentanil was 360 (278-720) microg. Patient controlled analgesia is a useful method of supplementing subarachnoid anaesthesia for caesarean section. The technique is simple to use and in this group there were no troublesome side effects.