Impact of epidural labor analgesia using sufentanil combined with low-concentration ropivacaine on maternal and neonatal outcomes: a retrospective cohort study

Abstract

Background Whether epidural administered sufentanil combined with low-concentration ropivacaine affected labor progress as well as maternal and neonatal outcomes still remained unknown. The aim of this study was to assess the impact of epidural sufentanil plus ropivacaine on maternal and neonatal outcomes. Methods This is a retrospective cohort study. Data of singleton full-term pregnancy women who received epidural labor analgesia for vaginal delivery from May 2018 to June 2020 were collected. Parturients were divided into two groups (the R group and the SR group) according to different medication regimens for epidural labor analgesia. The implementation of epidural analgesia during labor was performed with 0.167 % ropivacaine in the R group and 0.1 % ropivacaine in combination with 0.5 µg/ml sufentanil in the SR group. The primary outcome of our study included the duration of labor progress and the incidence of maternal fever, postpartum hemorrhage, fetal distress and neonatal Apgar scores less than 7 at 1 and 5 min. The secondary outcome included the incidence of episiotomy, instrumental delivery, caesarean section and grade III meconium-stained amniotic fluid. Results There were a total 3778 deliveries during the study period, 1994 and 1784 parturients were included in the R group and in the SR group, respectively. The length of the first stage of labor was remarkably shorter in the R group in comparison to the SR group (548.0 ± 273.0 vs. 570.9 ± 273.0, P = 0.013). No significant difference was found in the incidence of maternal fever, postpartum hemorrhage, fetal distress and in the neonatal Apgar scores less than 7 at 1 and 5 min between two groups. Other Maternal outcomes were comparable in the R group and the SR group. Conclusions 0.5 µg/ml sufentanil plus 0.1 % ropivacaine for epidural labor analgesia prolonged the duration of the first stage of labor, but did not have additional impact on maternal and neonatal outcomes compared with the sole 0.167 % ropivacaine. Trial registration Clinical Research Information Service with registration number ChiCTR2100045162. Registered 7 April 2021.

The Effect of Epidural Analgesia on Labour and Neonatal and Maternal Outcomes in 1, 2a, 3, and 4a Robson’s Classes: A Propensity Score-Matched Analysis

“…The latter report suggests that opioids can diffuse from the epidural space into the maternal blood and placenta, which can affect the respiratory centre of the neonate [ 27 ]. According to other recently published studies [ 28 ], adding opioids to the local anaesthetic effectively enhances the analgesic effect and thus reduces the consumption of local anaesthetic. No influence on neonatal outcomes was reported in the present analysis.…”

Efficacy and safety of different doses of epidural morphine coadministered with low-concentration ropivacaine after cesarean section: A retrospective cohort study

“…Low-concentration of ropivacaine coadministered with opioid including morphine has been a common protocol used in epidural analgesia after CS ( Zhang et al, 2021 ; Wang et al, 2022 ). Adding morphine to epidural local anesthetics can effectively enhance the analgesia effect and concomitantly reduce the incidence of adverse reactions caused by local anesthetics.…”

“…Ropivacaine is more recommended for little influence on the hemodynamics, shorter duration of sensory block and motor block and low incidence rate of adverse reactions, which facilitates the recovery and thus epidural ropivacaine has been suggested as superior to bupivacaine for postoperative pain control ( Fischer et al, 2000 ; Aşik et al, 2002 ; Wang et al, 2019 ). The literature has shown that the use of 0.1% ropivacaine as epidural analgesia can provide preferable analgesic potency, and adverse effects becomes more frequent with increasing of the concentration of ropivacaine, especially the motor blockade ( Miao et al, 2021 ; Otao et al, 2021 ; Zhang et al, 2021 ). In our study, no lower limb motor weakness was reported in any case, which was in line with previous studies.…”

Cytochrome P4503A4 gene polymorphisms guide safe sufentanil analgesic doses in pregnant Chinese mothers: a multicenter, randomized, prospective study

“…Sufentanil is widely used as an intravenous, subarachnoid, epidural anesthetic, and also adjuncts in epidural labor analgesia, with rapid onset, stronger actions, and high lipid solubility [5,6]. Studies have shown that when compared with ropivacaine alone, sufentanil plus ropivacaine induces better pain relief, reduces cesarean section incidence and adverse reactions during epidural labor analgesia [7,8]. However, during analgesia administration, excessive quantities may prolong labor and even affect maternal health (hypotension) and also newborns (heart rate abnormalities) [1].…”