Determination of the Full Dose–Response Relation of Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine, Combined with Sufentanil, for Labor Analgesia

Velde, Marc Van de; Dreelinck, Rebekka; Dubois, Jasperina; Kumar, Ariane; Deprest, Jan; Lewi, Liesbeth; Vandermeersch, Eugéne

doi:10.1097/00000542-200701000-00024

Cited by 62 publications

(53 citation statements)

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“…The use of ropivacaine for EA in labor has increased, in part because it has been considered less cardiotoxic and neurotoxic than bupivacaine 1 and because it has been associated with lower incidence of motor block 2,3 and better outcome for the newborn. 4,5 Recently, the combined spinal-epidural technique has gained popularity in labor analgesia.…”

Section: Introductionmentioning

confidence: 99%

“…10 The ideal dose of intrathecal sufentanil in addition to a low dose of local anesthetic (LA) varies between 1.5µg and 5µg. 3,11 With Neurological and Adaptive Capacity Scores (NACS), the effects of intrapartum drugs on the neonate can be observed. 12 The aim of this study was to use a randomized trial to compare analgesia and anesthesia with CSE and EA on women in labor and their newborns.…”

Section: Introductionmentioning

confidence: 99%

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Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Nakamura¹,

Ganem²,

Rugolo³

et al. 2009

Rev. Assoc. Med. Bras.

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Summary objectIve. Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. Methods. Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group) and 5 µg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison. results. There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination. conclusIon. EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Nakamura¹,

Ganem²,

Rugolo³

et al. 2009

Rev. Assoc. Med. Bras.

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“…Although quantal data can be analysed using updown methodology to define specific endpoints such as ED 50 [5,6], traditionally, regression techniques are used to generate full dose-response curves, which, by interpolation and extrapolation, cover the complete range of doses and responses [1][2][3]. A difficulty in quantal studies is that the measured endpoint or dependent variable is constrained to vary between 0 and 1, which is not suitable for linear regression.…”

Section: Overview Of Traditional Quantal Dose-response Analysismentioning

confidence: 99%

“…In obstetric anaesthesia, these investigations have frequently focused on local anaesthetics administered spinally and epidurally for labour analgesia [1][2][3].…”

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confidence: 99%

Multi‐dimensional response–probability–dose curves for bupivacaine and ropivacaine epidural labour analgesia

Kee

Lee

2013

Anaesthesia

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SummaryDescribing the relationship between magnitude of response, probability of response, dose and time is difficult using traditional two-dimensional dose-response curves. We devised a novel way of presentation in four dimensions. Data from a previous study of epidural bupivacaine and ropivacaine given for labour analgesia were re-analysed. For a range of response magnitudes (5-95% reduction in pain score), estimates of doses associated with probabilities of response 0.05-0.95 were calculated using probit analysis. Three dimensional surface plots were constructed with axes x = magnitude of response, y = probability of response and z = log(dose) at intervals for 30 min. Arithmetic interpolation was used to assemble an animation depicting temporal changes in relationship between variables (fourth dimension). Response-probability-dose curves in three and four dimensions were constructed and presented for both drugs. We believe that this model is more aligned with the logic of clinical dose selection compared with traditional two-dimensional curves.

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“…Van de Velde et al were the first to construct the full dose response relationship of spinal ropivacaine, levobupivacaine and bupivacaine combined with opioids for labor analgesia (128). These investigators noted that bupivacaine was significantly more potent then both other local anesthetics and that ropivacaine and levobupivacaine were of similar potency (128).…”

Section: Initiation Of Neuraxial Analgesiamentioning

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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Determination of the Full Dose–Response Relation of Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine, Combined with Sufentanil, for Labor Analgesia

Abstract: This full dose-response study suggests that ropivacaine and levobupivacaine are of similar potency, whereas bupivacaine is more potent than both other drugs.

Cited by 62 publications

References 1 publication

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Multi‐dimensional response–probability–dose curves for bupivacaine and ropivacaine epidural labour analgesia

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

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