Comparison of three different concentrations of levobupivacaine for epidural labor analgesia: Clinical effect and pharmacokinetic profile

El-Shaarawy, Ahmed Mostafa; Asfour, Mohamed S; Rashwan, Doaa; Amer, Mahmoud; El-Menshawe, Shahira F; Elkomy, Mohammed H.

doi:10.4103/aer.aer_145_17

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…In our study, motor block was never observed in the top-up group and rare also in the PIEB group (1%), demonstrating that this automated administration device can preserve women ability of moving and assuming whatever position during labor and delivery. In literature, the incidence of motor blockade is usually significantly higher, ranging between 30 and 50% of labor epidural analgesia [13,[18][19][20][21][22]. Although Tixier and colleagues observed no differences in motor block by comparing levobupivacaine 0.0625% and 0.125% [23], there is a strong view that the risk of motor block increases with increasing concentration of local anesthetics and the use of continuous infusion [13].…”

Section: Discussionmentioning

confidence: 99%

Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

Rinaldi¹,

Ghirardini²,

Troglio

et al. 2021

J Anesth Analg Crit Care

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Background Automated continuous epidural administration of local anesthetics provides a more stable analgesic block with decreasing of healthcare staff compared to manual boluses administration (TOP-UP) but is associated to high rate of operative vaginal delivery. We hypothesized that the use of programmed intermittent automated boluses (PIEB) is able to provide a good quality of analgesia and decreasing of anesthesiologic workload without increasing the rate of instrumental vaginal birth in comparison with TOP-UP technique. Laboring nulliparous woman aged between 18 and 46 years were randomized to epidural analgesia with 0.0625% levobupivacaine and sufentanil administered by PIEB or by TOP-UP techniques. Primary outcome was instrumental vaginal delivery rate and secondary outcomes were quality of analgesia, total and time-related drugs doses used, motor block, newborn outcome, and anesthesiologic workload. Results Six hundred twenty-nine were randomized, and 628 were included in the intention-to-treat analysis. The rate of instrumental vaginal delivery was similar in the PIEB and TOP-UP groups (13.2% vs 9.7%, OR 1.4 95% CI 0.8 to 2.5; p 0.21). There was no difference between groups regarding mode of delivery (cesarean section vs vaginal birth), newborn outcome, and motor block. Patients in the PIEB group received more total and time-related drugs doses and a better quality of analgesia. Anesthesiological workload was significantly reduced in the PIEB group. Conclusions Our study demonstrated that epidural anesthesia with programmed intermittent epidural boluses by an automated device provides an effective and safe management of labor analgesia with improvement of pain control and sparing of man workload compared to manual top-up protocols.

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Section: Discussionmentioning

confidence: 99%

Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

Rinaldi¹,

Ghirardini²,

Troglio

et al. 2021

J Anesth Analg Crit Care

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“…Five studies were published between 2011 and 2021 (511 women) [9, 11–14]. A total of 147 women received high concentration, 194 received low concentration and 170 received ultra‐low concentration.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies were published between 2011 and 2021 (511 women) [9,[11][12][13][14]. A total of 147 women received high in the main analysis, but with wider credible intervals.…”

Section: Mode Of Delivery Limited To Papers Published In the Last 10 ...mentioning

confidence: 99%

Comparison of ultra‐low, low and high concentration local anaesthetic for labour epidural analgesia: a systematic review and network meta‐analysis

et al. 2022

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Summary Lumbar epidural is the gold standard for labour analgesia. Low concentrations of local anaesthetic are recommended. This network meta‐analysis investigated whether further reducing the concentration of local anaesthetic can improve maternal and neonatal outcomes without compromising analgesia. We conducted a systematic search of relevant databases for randomised controlled trials comparing high (>0.1%), low (>0.08% to ≤0.1%) or ultra‐low (≤0.08%) concentration local anaesthetic (bupivacaine or equivalent) for labour epidural. Outcomes included mode of delivery, duration of labour and maternal/neonatal outcomes. Bayesian network meta‐analysis with random‐effects modelling was used to calculate odds ratios or weighted mean differences and 95% credible intervals. A total of 32 studies met inclusion criteria (3665 women). The total dose of local anaesthetic received increased as the concentration increased; ultra‐low compared with low (weighted mean difference −14.96 mg, 95% credible interval [−28.38 to −1.00]) and low compared with high groups (weighted mean difference −14.99 [−28.79 to −2.04]), though there was no difference in the number of rescue top‐ups administered between the groups. Compared with high concentration, ultra‐low concentration local anaesthetic was associated with increased likelihood of spontaneous vaginal delivery (OR 1.46 [1.18 to 1.86]), reduced motor block (Bromage score >0; OR 0.32 [0.18 to 0.54]) and reduced duration of second stage of labour (weighted mean difference −13.02 min [−21.54 to −4.77]). Compared with low, ultra‐low concentration local anaesthetic had similar estimates for duration of second stage of labour (weighted mean difference −1.92 min [−14.35 to 10.20]); spontaneous vaginal delivery (OR 1.07 [0.75 to 1.56]; assisted vaginal delivery (OR 1.35 [0.75 to 2.26]); caesarean section (OR 0.76 [0.49 to 1.22]); pain (scale 1–100, weighted mean difference −5.44 [−16.75 to 5.93]); and maternal satisfaction. Although a lower risk of an Apgar score < 7 at 1 min (OR 0.43 [0.15 to 0.79]) was reported for ultra‐low compared with low concentration, this was not sustained at 5 min (OR 0.12 [0.00 to 2.10]). Ultra‐low concentration local anaesthetic for labour epidural achieves similar or better maternal and neonatal outcomes as low and high concentration, but with reduced local anaesthetic consumption.

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“… 4 , 5 Motor blockade following epidural analgesia has been directly associated with the concentration of local anesthetic used; the higher the concentration of local anesthetic, the greater the motor blockade in the pelvic floor and lower limb muscles. 1 , 5 , 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

“…2,3 In addition, the strong motor blockade achieved following the administration of traditional epidural analgesia could be one of the factors prolonging the second stage of labor, increasing the risk of instrumental birth. 4,5 Motor blockade following epidural analgesia has been directly associated with the concentration of local anesthetic used; the higher the concentration of local anesthetic, the greater the motor blockade in the pelvic floor and lower limb muscles. 1,[5][6][7] In recent years, a new approach to epidural analgesia has emerged, known as low-dose epidural analgesia or walking epidural analgesia.…”

Section: Introductionmentioning

confidence: 99%

Influence of Laboring People's Mobility and Positional Changes on Birth Outcomes in Low‐Dose Epidural Analgesia Labor: A Systematic Review with Meta‐Analysis

Verastegui-Martín

Paz-Fresneda²,

Jiménez‐Barbero

et al. 2022

J Midwife Womens Health

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Introduction Freedom of movement has been identified as a key issue for pregnant individuals during the birthing process, even if they opt for epidural analgesia, which has relegated people to more static positions during birth for many years. The aims of this systematic review were to evaluate the influence of mobility and positional changes on perinatal and neonatal outcomes in people in labor with epidural analgesia, describe the range of movement interventions used during the first and second stage of labor, and describe the level of motor blockade among people with low‐dose epidural analgesia. Methods Bibliographic databases (Web of Science, Cochrane, CINAHL) were consulted from December 2020 to January 2021. The articles selected were clinical trials and observational or analytical studies, the subject of which was mobilization during labor in people with epidural analgesia. The outcome measures were mode of birth, duration of labor, and extrauterine adaptation after birth. A narrative synthesis was used to describe the types of movements interventions employed during the stages of labor and the level of motor blockade among people with low‐dose epidural analgesia. Results Ten articles were selected (8 clinical trials, one cross‐sectional study, and one quasiexperimental study), with a total sample of 6086 individuals. A meta‐analysis showed nonsignificant results between groups for mode of birth (relative risk [RR], 1.00; 95% CI, 0.87‐1.14), duration of labor (RR, 1.64; 95% CI, ‐34.57 to 37.86), and extrauterine adaptation after birth (RR, 0.86; 95% CI, 0.39‐1.93). There was heterogeneity among studies in the type of movement interventions used during the first and second stage of labor. Discussion Although no clear benefit was observed for mobilization in epidural labor, no detrimental effects were found either, so perinatal care providers should encourage mobilization if the laboring person so desires, throughout the entire childbirth process.

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Comparison of three different concentrations of levobupivacaine for epidural labor analgesia: Clinical effect and pharmacokinetic profile

Cited by 5 publications

References 17 publications

Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

Comparison of ultra‐low, low and high concentration local anaesthetic for labour epidural analgesia: a systematic review and network meta‐analysis

Influence of Laboring People's Mobility and Positional Changes on Birth Outcomes in Low‐Dose Epidural Analgesia Labor: A Systematic Review with Meta‐Analysis

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