Comparison of the efficacy and safety between the use of ropivacaine alone and ropivacaine with sufentanil in epidural labor analgesia / 临床麻醉学杂志

ABSTRACT

Objective To compare the analgesic efficacy and safety of the sole local anesthetic ropivacaine with the combination of both local anesthetic ropivacaine and opioidergic analgesic sufen-tanil given epidurally on the labor pain control.Methods After institutional review board approval and patient consent,a total of 481 nulliparas requesting epidural labor analgesia were randomized into two groupsa sole local anesthetic group (0.125% ropivacaine,group R)and a combination of local anesthetic and opioidergic analgesic group (0.125% ropivacaine+0.3 μg/ml sufentanil,group RS). Analgesic efficacy was measured using numerical rating scale (NRS)of pain and maternal visual ana-logue scale (VAS)analgesia satisfaction with regard to the first and the second stage of labor.Anal-gesic safety was measured with the Bromage scale of maternal safety and epidural labor analgesia re-lated side effects,as well as fetal safety including Apgar scoring and umbilical cord artery blood gas a-nalysis.Results A total of 346 participants completed the study,with 1 64 and 182 women in each group R and RS,respectively.The median NRS pain score during the first stage of labor was signifi-cantly lower in the combination group (2.2,IQR1.8-2.7 )comparing to the sole local analgesic group (2.4,IQR2-2.8)(P <0.001).No significant difference was observed in NRS pain score dur-ing the second stage of labor.Patients in both groups were rated the same VAS satisfaction of analge-sia.Patients in the sole local analgesic group experienced fewer side effects than those in the combina-tion group (37.7% versus 47.2%,P =0.082).The incidence of 1-min Apgar≤7 was lower in the sole local analgesic group 2 (1.2%) than the combination group 10 (5.5%) (P < 0.05 ). Conclusion The sole local anesthetic ropivacaine produces a comparable labor analgesic effect as the combination of both local anesthetic ropivacaine and opioidergic analgesic sufentanil but the former has less maternal side effects,and less incidence of lower 1-min Apgar scoring.