Comparison of 0.0625%,0.075% and 0.1% ropivacaine on Epidural-Related Maternal Fever and inflammatory factors: a prospective and randomized control trial

Abstract

Backgroud: Women in labor who receive epidural analgesia are more likely to experience intrapartum fever, which is defined as Epidural-related maternal fever (ERMF). The mechanisms of ERMF remain incompletely understood. At present, there are no effective means to prevent epidural-associated fever. This study was to investigate the effects of different concentrations of ropivacaine on intrapartum fever and pyrogenic factors during epidural labor analgesia. Methods 123 full-term single first-term primiparas who were hospitalized for delivery and willing to receive patient-controlled epidural analgesia (PCEA) were selected as research objects. Analgesia was randomly provided with one of three groups: (Group A) 0.0625% ropivacaine with 1ug/ml fentanyl, (Group B) 0.075% ropivacaine with 1ug/ml fentanyl, (Group C) 0.1% ropivacaine with 1ug/ml fentanyl. The primary outcome was the tympanic temperature. The secondary outcomes included plasma inflammatory factor levels, VAS score, labor duration and neonatal Apgar score. Results At T2(T2 = four hours after analgesia), the average body temperature of Group C was higher than that of the other two groups (P < 0.05, Table 2), but there was no significant difference between Group A and Group B (P > 0.05, Table 2). At T3(T3 = eight hours after analgesia), the average temperature of Group C was higher than that of Group B and that of Group B was higher than that of Group A (P < 0.05, Table 2). At T2, plasma thermogenesis factors IL-6, TNF-α, PGE2 and RANTES in Group C were higher than those in Group A and Group B (P < 0.05), but there was no significant difference between Group A and group B (P > 0.05). At T3, the above inflammatory factors in group C were higher than those in group B (P < 0.05), and those in group B were higher than those in group A (P < 0.05). There were no significant differences in delivery time, VAS score and neonatal Apgar score among the three groups (P > 0.05). Conclusions This study suggests that lower concentration of ropivacaine results in lower tympanic temperature, which was associated with lower levels of inflammatory factors. Trial registration: This prospective and randomized control trial was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/edit.aspx?pid=141149&htm=4, identification number: ChiCTR2100053761; principal investigator: Xiangqing Xiong; date of registration: 29/11/2021) before patient enrollment.