Comparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia

Bölükbaşı, Demet; Şener, Elif Bengi; Sarıhasan, Binnur; Kocamanoglu, Serhat; Tür, Ayla

doi:10.1016/j.ijoa.2005.04.007

Cited by 21 publications

(15 citation statements)

References 28 publications

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“…9 They concluded that there was no major advantage of continuous epidural infusion of ropivacaine 0.0625% plus fentanyl 2 microg/mL over bupivacaine 0.0625% plus fentanyl 2 microg/mL for labor analgesia. We believe that different methods or dosages may be tried in order to improve comfort at the second stage of labor and the delivery.…”

Section: Discussionmentioning

confidence: 99%

Onset and duration of epidural analgesia with bupivacaine and bupivacaine plus fentanyl: a comparative study

Umapathy

Ayathullah

2017

Int J Res Med Sci

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Background: Bupivacaine has got the more cardiac toxicity due to high degree of protein binding. There have been many attempts for improving the duration and onset of epidural block. Fentanyl when administered epidurally was found to reduce the requirement of doses by double in some cases. The objective of the study was to compare the efficacy of bupivacaine plus fentanyl in terms of onset and duration of epidural analgesia. Methods: A clinical study was undertaken to evaluate the onset and duration of analgesia with bupivacaine and mixture of bupivacaine plus fentanyl when given epidurally for patients undergoing lower limb orthopedic surgeries. The study was undertaken in 50 patients who were divided into two groups of 25 each. The patients were undergoing surgery in orthopedic theatre at S. V. S. Medical College and Hospital. Patients studied comprised of both the sexes between the 18-55 years of age. Results: It is seen that the onset of analgesia was equal in both the groups 72% of patients in group II had excellent quality of intra operative analgesia compared to only 36% of patients in group I. This difference was found to be statistically significant (p<0.05). It was seen that none of the patients had analgesia of less than 1 hour 30 minutes. The two-segment regression time was uniformly distributed amongst the two groups. It was found that the incidence of intra operative complications like bradycardia, hypotension, nausea/vomiting were almost equal in both the groups. It was found that the duration of post-operative analgesia in patients of two groups was almost equal. Conclusions: Addition of fentanyl to bupivacaine was found to increase the quality of intra operative analgesia. Otherwise there was no added advantage over bupivacaine alone.Keywords: Analgesia, Bupivacaine, Complications, Fentanyl DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172995Umapathy P et al. Int J Res Med Sci. 2017 Jul;5(7):3103-3106 International Journal of Research in Medical Sciences | July 2017 | Vol 5 | Issue 7 Page 3104 may vary. It produces motor as well as sensory block. Ropivacaine is an analog of mepivacaine. It has a shorter duration of motor block and also a lower toxicity as compared to bupivacaine. 2Bupivacaine has got the more cardiac toxicity due to high degree of protein binding. There have been many attempts for improving the duration and onset of epidural block. There were attempts of addition of sodium bicarbonate in different concentrations, epinephrine, phenyl epinephrine etc. However ultimately it was clear that opioids can augment the effects of these local anesthetics for use in epidural space. Fentanyl when administered epidurally was found to reduce the requirement of doses by double in some cases. 3Even though opioids were found to be effective, they do have their own side effects. Itching, vomiting, nausea, hypotension and urinary retention are some of them. Alpha adrenergic agonists like clonidine can also be used instead of opioids. 4 When clonidine is added to opioids, it gives an a...

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Section: Discussionmentioning

confidence: 99%

Onset and duration of epidural analgesia with bupivacaine and bupivacaine plus fentanyl: a comparative study

Umapathy

Ayathullah

2017

Int J Res Med Sci

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“…43 Normally EDA analgesia is started with a bolus dose of a dilute solution of a local anesthetic and an opioid, and maintained by continuous infusion. 34,54,55 This epidural solution can be administrated as regular top-ups (bolus by midwife), continuous infusion, conventional patient-controlled epidural analgesia (PCEA), 8,[56][57][58][59] or computer integrated PCEA. 35,[60][61][62][63][64] The use of PCEA and computer integrated bolus doses have by some authors been advocated to optimize analgesia and prevent breakthrough pain resulting in a reduced consumption of local anesthetics.…”

Section: Regional Analgesiamentioning

confidence: 99%

Remifentanil as analgesia for labour pain

Tveit

2013

Acta Anaesthesiol Scand

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Background To collect updated information about pharmacological labour analgesia in Norway, especially systemic opioids and epidural. Evaluation of efficacy and safety with remifentanil intravenous patient‐controlled analgesia (IVPCA) for pain relief during labour. To compare remifentanil IVPCA with epidural analgesia (EDA) regarding efficacy and safety during labour. Methods In paper I, two national surveys identified Norwegian labour analgesia methods and changes during the study period (2005–2008). Paper II is a prospective, observational study of analgesic efficacy and safety with remifentanil IVPCA. Paper III is a prospective, randomized controlled trial comparing remifentanil IVPCA with EDA regarding analgesic efficacy and safety. Results The surveys in paper I found the frequency of EDA in Norwegian hospitals to be increasing, but still low (25.9%) compared with other western countries. Nitrous oxide and traditional systemic opioids, like pethidine, were frequently used. In paper II, remifentanil IVPCA was found to give satisfactory labour analgesia in more than 90% of the parturients with an average maximal pain reduction of 60%. Maternal oxygen desaturation and sedation were acceptable, and neonatal data reassuring. In paper III, a randomized controlled trial found remifentanil IVPCA and EDA to be comparable both regarding analgesic efficacy (pain reduction; Fig. ) and maternal satisfaction. Remifentanil IVPCA produced more maternal sedation and oxygen desaturation; neonatal outcome was reassuring in both groups. Reduction in pain score [visual analogue scale (VAS)] during labour analgesia with patient‐controlled intravenous remifentanil and continuous epidural infusion with ropivacaine and fentanyl. Conclusion The frequency of epidural labour analgesia in Norway has increased, but is still relatively low. Nitrous oxide and traditional systemic opioids are frequently used. The clinical practice seems conservative; newer short‐acting opioids are seldom used for systemic labour analgesia. The studies on remifentanil IVPCA revealed adequate pain relief, high maternal satisfaction, and no serious neonatal side effects. There were no differences in analgesic efficacy, maternal satisfaction, and neonatal outcome when comparing remifentanil IVPCA with EDA. However, remifentanil caused maternal sedation and oxygen desaturation. We recommend the use of IVPCA remifentanil as labour analgesia instead of traditional opioids as pethidine and morphine when EDA is not an option. The presence of skilled personnel and close monitoring is mandatory.

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“…Pri donošenju odluke koji lokalni anestetik da upotrebimo, treba imati na umu da su bupivakain i levobupivakain nešto potentniji od ropivakaina, a da bupivakain daje veću kardiotoksičnost i neurotoksičnost i viši rizik od motorne blokade nego levobupivakain i ropivakain [28][29][30][31]. Kada se koriste male koncentracije lokalnih anestetika, a porođaj relativno kratko traje, te razlike nisu klinički značajne, međutim, u situacijama gde predviđamo duže trajanje porođaja ili realnu mogućnost dovršenja porođaja carskim rezom i gde će ukupna potrošnja anestetika biti veća, levobupivakain ili ropivakain bili bi sigurniji izbor [30].…”

Section: Epiduralna Analgezija U Porođaju: čIme?unclassified

Epidural analgesia in labor: specific characteristics, dilemmas and controversies

Kutlešić

Kutlesic

2012

Med pregl

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Comparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia

Cited by 21 publications

References 28 publications

Onset and duration of epidural analgesia with bupivacaine and bupivacaine plus fentanyl: a comparative study

Onset and duration of epidural analgesia with bupivacaine and bupivacaine plus fentanyl: a comparative study

Remifentanil as analgesia for labour pain

Epidural analgesia in labor: specific characteristics, dilemmas and controversies

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