Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor

Guo, Shanbin; Li, Bo; Gao, Chengjie; Tian, Yue

doi:10.1097/md.0000000000000880

Cited by 22 publications

(18 citation statements)

References 37 publications

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“…5 Similar to our study, Guo S et al, in their metaanalysis also found that Analgesia with ropivacaine in combination with fentanyl is associated with lower incidence of motor blocks in comparison with bupivacaine and fentanyl at a similar ratio (0.1%: 0.0002%). 19 Meister GC et al, also observed similar results to our study. In contrast, Halpern SH et al, observed that there was no significant difference between the two drugs in the mode of delivery, maternal satisfaction, or neonatal outcomes.…”

Section: Discussionsupporting

confidence: 92%

“…18 Most studies and reviews have found epidural Ropivacaine and Bupivacaine, with or without opioids, to be similar when compared at equal concentrations ranging from 0.125 to 0.25% for maintenance of labor analgesia and this may not be consistent with different concentrations and their analgesic potency must also be considered. 5,15,16,[19][20][21] In this study, Bupivacaine group needed a higher number of top-ups compared to Ropivacaine group. Only 28% in the Ropivacaine group needed 3 top ups or more compared to 76% in Bupivacaine group.…”

Section: Discussionmentioning

confidence: 66%

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A clinical study of comparison of effect with 0.15% ropivacaine and fentanyl 2mcg/ml versus 0.125% bupivacaine and fentanyl 2mcg/ml epidurally for labour analgesia

Kumar

Kanna²,

Kirubahar³

et al. 2018

Int J Res Med Sci

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Background: Adequate pain control is vital during labor as it can have negative impacts on maternal and fetal physiology. Epidural Bupivacaine with opioid has been in use for many years. Ropivacaine is almost similar to bupivacaine in terms of onset, duration, and quality of sensory blockade, but it is less toxic and produces less motor blockade.Methods: Authors did a prospective randomized controlled study on 50 prim gravidas of ASA I category with singleton pregnancy in full-term labor, undergoing normal vaginal delivery, admitted to the antenatal ward requesting labor analgesia. They were randomly divided into two groups of 25 each receiving 8 ml Epidural bolus of either 0.125% Bupivacaine with 2ug/ml Fentanyl or 0.15% Ropivacaine with 2ug/ml Fentanyl by the epidural catheter.Results: Analgesia in Ropivacaine group lasted 7.84 minutes longer than Bupivacaine group (p<0.001). Only 28% in the Ropivacaine group needed 3 analgesia top-ups or more compared to 76% in Bupivacaine group. No one out of 25 subjects in Ropivacaine group developed motor block, whereas 21 subjects (84%) in Bupivacaine group developed partial motor (grade 2) block. There was no significant difference in maternal or neonatal outcome between the groups.Conclusions: Subjects in Ropivacaine group on comparison with Bupivacaine group experienced excellent labor analgesia, with greater duration of action, and reduced fentanyl, a local anesthetic requirement with similar VAS scores, maternal and neonatal outcomes besides the major advantage of reduced incidence of motor block.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 66%

A clinical study of comparison of effect with 0.15% ropivacaine and fentanyl 2mcg/ml versus 0.125% bupivacaine and fentanyl 2mcg/ml epidurally for labour analgesia

Kumar

Kanna²,

Kirubahar³

et al. 2018

Int J Res Med Sci

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show abstract

“…Previously, significantly lower incidence of motor blocks is reported in parturient mothers who received epidural analgesia with ropivacaine and fentanyl (18.4%) than in women who received bupivacaine and fentanyl (32.8%) for labor epidural analgesia . This may be due to the low lipophilic characteristics of ropivacaine which make it resistant to a rapid penetrance in the myelinated nerve fibers .…”

Section: Discussionmentioning

confidence: 96%

Motor blocks and operative deliveries with ropivacaine and fentanyl for labor epidural analgesia: A meta‐analysis

Zhang

Qin²,

Hui

2018

J of Obstet and Gynaecol

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“…7 Asik et al concluded that epidural bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl produced equivalent analgesia for pain relief during labor and delivery. 8 It is concluded that ropivacaine 0.2% combined with fentanyl 2 microg mL (-1) provided effective analgesia with significantly less motor block and need for an instrumental delivery than a bupivacaine/fentanyl combination at the same concentrations during labor and 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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Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor

Cited by 22 publications

References 37 publications

A clinical study of comparison of effect with 0.15% ropivacaine and fentanyl 2mcg/ml versus 0.125% bupivacaine and fentanyl 2mcg/ml epidurally for labour analgesia

A clinical study of comparison of effect with 0.15% ropivacaine and fentanyl 2mcg/ml versus 0.125% bupivacaine and fentanyl 2mcg/ml epidurally for labour analgesia

Motor blocks and operative deliveries with ropivacaine and fentanyl for labor epidural analgesia: A meta‐analysis

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

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