Effects of Local Anesthetic on the Time Between Analgesic Boluses and the Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

Abstract

(1):70-76 RESUMOIntrodução: A patient-controlled epidural analgesia com baixas concentrações de anestésicos é eficaz na redução da dor de parto. O objectivo deste estudo foi comparar dois regimes de doses ultrabaixas de ropivacaína e sufentanil (0,1% ropivacaína associada a 0,5 µg.ml -1 sufentanil vs. 0,06% ropivacaína associada a 0,5 µg.ml -1 sufentanil) nos intervalos entre bólus e na duração do trabalho de parto. Material e Métodos: Neste estudo prospectivo não-randomizado, realizado entre Janeiro e Julho de 2010, dois grupos de parturientes receberam patient-controlled epidural analgesia: o Grupo I (n = 58; 1 mg.ml -1 ropivacaína + 0,5 µg.ml -1 sufentanil) e o Grupo II (n = 57; 0,6 mg.ml -1 ropivacaína + 0,5 µg.ml -1 sufentanil). Quando necessário administraram-se doses de resgate de ropivacaína na concentração definida para cada grupo e sem sufentanil. Registaram-se a dor, os consumos de analgésicos, as características do bloqueio neuroaxial, do trabalho de parto, do recém-nascido, e a satisfação materna. Resultados: A dose de ropivacaína foi maior no Grupo I (9,5 [7,7-12,7] No Grupo I observouse um aumento do intervalo de tempo entre bólus (beta = 32,61 min, 95% CI [25,39; 39,82], p < 0,001), enquanto no Grupo II se observou uma diminuição dos intervalos (beta = -1,40 min, 95% CI [-2,44; -0,36], p = 0,009). A duração do segundo estadio do trabalho de parto foi significativamente maior no Grupo I do que no Grupo II (78 min vs. 65 min, p < 0,001). Conclusões: As parturientes que receberam ropivacaína a 0,06% exibiram uma menor evidência de efeitos cumulativos e um segundo estadio do trabalho de parto mais rápido do que as que receberam ropivacaína a 0,1%. Palavras-chave: Analgesia Controlada pelo Doente; Analgesia Obstétrica; Dor do Parto; Ropivacaína; Sufentanil. ABSTRACTBackground: Patient-controlled epidural analgesia with low concentrations of anesthetics is effective in reducing labor pain. The aim of this study was to assess and compare two ultra-low dose regimens of ropivacaine and sufentanil (0.1% ropivacaine plus 0.5 µg.ml-1 sufentanil vs. 0.06% ropivacaine plus 0.5 µg.ml -1 sufentanil) on the intervals between boluses and the duration of labor. Material and Methods: In this non-randomized prospective study, conducted between January and July 2010, two groups of parturients received patient-controlled epidural analgesia: Group I (n = 58; 1 mg.ml -1 ropivacaine + 0.5 µg.ml -1 sufentanil) and Group II (n = 57; 0.6 mg.ml -1 ropivacaine + 0.5 µg.ml -1 sufentanil). Rescue doses of ropivacaine at the concentration of the assigned group without sufentanil were administered as necessary. Pain, local anesthetic requirements, neuraxial blockade characteristics, labor and neonatal outcomes, and maternal satisfaction were recorded. Results: The ropivacaine dose was greater in ] mg.h -1 vs. 6.1 [5.1-9.8 mg.h -1 ], p < 0.001). A time increase between each bolus was observed in Group I (beta = 32.61 min, 95% CI [25.39; 39.82], p < 0.001), whereas a time decrease was observed in Group II (beta = -1.40 min, 95% CI ...

Effect of epidural labor analgesia on postpartum depression and maternal and infant outcomes in parturients with gestational diabetes mellitus---A prospective cohort study

“…In the present study, epidural labor analgesia signi cantly prolonged the rst and second stages of labor, but the durations of these stages were still within the normal ranges (Table 2), as experts have concluded that the upper limit for the second stage delivery should be 4 h for primiparas with epidural analgesia and 3 h for primiparas without epidural analgesia [71]. Previous studies have also reported that epidural labor analgesia can prolong the rst and second stages of labor [22,[72][73][74], which is consistent with our results. Inconsistently though, two studies [22,75] reported that epidural administration of 0.08% ropivacaine and 0.4 µg/ml sufentanil did not prolong the second stage of labor.…”