A Comparison of Epidural Analgesia with 0.125% Ropivacaine with Fentanyl Versus 0.125% Bupivacaine with Fentanyl during Labor

Meister, Greg C.; D’Angelo, Robert; Owen, Medge D.; Nelson, Kenneth E.; Gaver, Renee

doi:10.1097/00000539-200003000-00024

Cited by 129 publications

(60 citation statements)

References 15 publications

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“…Similarly, during the second stage of labor also VAS score was comparable at any time. Meister et al [14] and Clément et al [11] observed that VAS score was comparable in both the groups throughout the labor. In this study, Apgar score was between 7 and 10 in most of the neonates, 93.33% in Group B and in 100% in Group R at 1 min and at 5 min and 6.67% neonates in Group B and no neonate in Group R had Apgar score between 5 and 6 at 1 min and at 5 min.…”

Section: International Journal Of Medical Science and Public Healthmentioning

confidence: 91%

“…In this study, there was no incidence of pruritus in either group. Chua et al [16] observed that none of the patients in either group (bupivacaine 0.125% and ropivacaine 0.125%) developed pruritus whereas Meister et al [14] observed that 56% patients of ropivacaine/ fentanyl group and 52% patients of bupivacaine/fentanyl group complained of pruritus, which did not require any treatment. In this study, 10% of patients in Group B and 6.7% in Group R had intrapartum urinary retention (patients catheterized with K-90 catheter).…”

Section: International Journal Of Medical Science and Public Healthmentioning

confidence: 99%

“…Eddleston et al [9] observed median upper level of sensory block was T8 in both the groups. Meister (2000) et al [14] observed that ropivacaine (0.125%) group developed mean T7 level and bupivacaine(0.125%) group developed mean T8 level. For the relief of pain during labor, the upper level of sensory block required is up to T10 dermatome.…”

Section: International Journal Of Medical Science and Public Healthmentioning

confidence: 99%

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Compare the efficacy of ropivacaine and bupivacaine with fentanyl for epidural labor analgesia

Gajjar¹,

Patel²

2017

Int J Med Sci Public Health

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INTRODUCTIONLabor, as the process of childbirth, is a painful experience for most of the women. The McGill pain questionnaire ranks pain in the upper part of pain scale between cancer and amputation of digit. Sir John Snow first administered chloroform to Queen Victoria for the birth of eighth Background: Attempts have been made to reduce or eliminate the pain associated with labor since ancient time. Obstetrics analgesia reached a new phase with lumbar epidural analgesia. We carried out a randomized study to evaluate and compare the analgesic efficacy of ropivacaine and bupivacaine with fentanyl on mother, on fetus and on the course of labor. Objectives: The aim of the present study was to evaluate and compare the analgesic efficacy of ropivacaine (0.125%) and bupivacaine (0.125%) with fentanyl on mother, fetus and on the course of labor, incidence of instrumental delivery, and the rate of cesarean section. Materials and Methods: Study was conducted in 60 term, primi or second gravida parturients with active phase of labor, with cervical dilatation 3-5 cm, with single fetus, vertex presentation belonging to American Society of Anesthesiology (ASA) Class I or II. The patients were randomly divided into two groups. After negative test dose, loading dose of 10 ml of 0.125% ropivacaine in Group R and 0.125% of bupivacaine in Group B with 2.5 µg/ml fentanyl in both groups was given as an initial dose for analgesia. Top up dose with 5 ml of 0.125% of ropivacaine in Group R and 0.125% bupivacaine in Group B were given when visual analog scale (VAS ≥3). For the second stage of labor 8 ml of 0.125% of ropivacaine in Group R and 0.125% of bupivacaine in Group B with 1.25 µg/ml fentanyl in both groups were given in sitting position to allow perineal analgesia. Results: In this study, we observed that maximum number of patients have developed sensory block up to T8, 50% in Group B and 53.3% in Group R, only 2 patients (6.7%) in Group B developed T6 level, and no patients in Group R. There was no significant difference in mean total dose of bupivacaine and ropivacaine (P > 0.05). In Group R total 22 patients and 3 in Group B developed Grade 0 motor blocked, which was statistically very significant. In Group B, 14 and 2 patients developed Grade 2 and Grade 3 motor blocked, respectively, compared to none of the patients in Group R which was statistically very significant. There was no significant difference in Apgar score and VAS scores between the groups at any time during the first and second stage of labor. Conclusions: Ropivacaine group patients required less number of top-up doses and developed significantly less motor block than bupivacaine group patients. We thus conclude that the combinations of 0.125% of ropivacaine with fentanyl and 0.125% bupivacaine with fentanyl is equally effective in producing excellent labor analgesia ensuring the safety of the mother and fetus.

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Section: International Journal Of Medical Science and Public Healthmentioning

confidence: 91%

Section: International Journal Of Medical Science and Public Healthmentioning

confidence: 99%

Section: International Journal Of Medical Science and Public Healthmentioning

confidence: 99%

See 1 more Smart Citation

Compare the efficacy of ropivacaine and bupivacaine with fentanyl for epidural labor analgesia

Gajjar¹,

Patel²

2017

Int J Med Sci Public Health

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“…(2) Mesiter et al, 4 where 102.5 ± 82 mg of 0.125% bupivacaine required against 113.0 ± 43.3 mg of 0.125% ropivacaine.…”

Section: Total Dose Of Local Anaesthetic Requiredmentioning

confidence: 99%

Comparison of 0.1% Bupivacaine With 2 McG/Ml Fentanyl and 0.1% Ropivacaine With 2 McG/Ml for Labour Analgesia

B¹,

S²

2018

jebmh

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BACKGROUNDEpidural neuraxial blockade is an efficient and an easy method of administering labour analgesia without any adverse effects on the foetus. Labour analgesia thus helps the mother enjoy the delivery of her child without pain or stress enhancing patient satisfaction. Bupivacaine was the routinely used local anaesthetic for labour analgesia. Bupivacaine combined with low dose of opioid was used to reduce the concentration of bupivacaine without compromising on quality of analgesia produced and also reducing the extent of motor blockade. But even with lowering the concentration of bupivacaine used and the addition of opioids, patient had minimal motor blockade which prevented them from being ambulant. Ropivacaine has helped us to provide ambulatory analgesia by overcoming the motor blockade without compromising on the quality of analgesia.The objective of this study was to compare analgesic efficacy, onset, duration of action, total dose of anaesthetic required, intensity of motor blockade and haemodynamic stability in patients admitted for safe confinement.

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“…Several individual studies using low concentrations of local anaesthetic (£ 0.125%) however did demonstrate differences in motor block with ropivacaine producing less motor block then bupivacaine (173)(174)(175)(176)(177)(178)(179)(180)(181). Gautier et al clearly demonstrated that, especially if the cumulative epidural dose of local anaesthetic increased, the risk of motor block was increased with bupivacaine (175).…”

Section: Excellent Labour Analgesia With Minimal Side-effectsmentioning

confidence: 99%

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

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A Comparison of Epidural Analgesia with 0.125% Ropivacaine with Fentanyl Versus 0.125% Bupivacaine with Fentanyl during Labor

Cited by 129 publications

References 15 publications

Compare the efficacy of ropivacaine and bupivacaine with fentanyl for epidural labor analgesia

Compare the efficacy of ropivacaine and bupivacaine with fentanyl for epidural labor analgesia

Comparison of 0.1% Bupivacaine With 2 McG/Ml Fentanyl and 0.1% Ropivacaine With 2 McG/Ml for Labour Analgesia

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

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