Relative Analgesic Potencies of Ropivacaine and Bupivacaine for Epidural Analgesia in Labor: Implications for Therapeutic Indexes

Polley, Linda S.; Columb, Malachy O.; Naughton, Norah N.; Wagner, Deborah; Ven, Cosmas J. M. van de

doi:10.1097/00132586-200004000-00023

Cited by 84 publications

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“…They measured the minimum local anesthetic concentration (MLAC) of ropivacaine and bupivacaine during first stage of labour using the approach suggested by Columb et al 9 The measured MLAC in Polley's 8 and Columb's 9 studies for bupivacaine respectively were 0.067%, and 0.064%, although Polley et al 1 0 in a previous study had determined the MLAC of bupivacaine to be 0.104%. The MLAC of ropivacaine was 0.111% in the study by Polly et al 8 and Columb et al 9 did not study ropivacaine.…”

Section: Discussionmentioning

confidence: 87%

“…7 Our study addressed the sensory and motor effects of the two anesthetics only during first stage of labour and no data were collected during "active pushing" during second stage. Polley et al 8 suggested that ropivacaine is less potent and that bupivacaine has a better toxic/therapeutic ratio. They measured the minimum local anesthetic concentration (MLAC) of ropivacaine and bupivacaine during first stage of labour using the approach suggested by Columb et al 9 The measured MLAC in Polley's 8 and Columb's 9 studies for bupivacaine respectively were 0.067%, and 0.064%, although Polley et al 1 0 in a previous study had determined the MLAC of bupivacaine to be 0.104%.…”

Section: Discussionmentioning

confidence: 99%

“…Polly et al 8 further suggested that only at equipotent analgesic concentrations should the relative motor and sensory effects of these two agents be compared. However, in their study, 35-45% of women were multiparous women at 3-7 cm dilatation and the MLAC was measured following a single 20 ml injection of either ropivacaine or bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125% — fentanyl infusions for epidural labour analgesia

Finegold

Mandell

Ramanathan

2000

Can J Anesth/J Can Anesth

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Purpose: To compare analgesic efficacies of ropivacaine-fentanyl and bupivacaine-fentanyl infusions for labour epidural analgesia. Methods:In this double-blind, randomized study 100, term, nulliparous women were enrolled. Lumbar epidural analgesia (LEA) was started at cervical dilatation < 5 cm using either bupivacaine 0.25% followed by bupivacaine 0.125% + 2 µg·ml -1 fentanyl infusion (n=50) or ropivacaine 0.2% followed by ropivacaine 0 .1% + 2 µg·ml -1 fentanyl infusion (n=50). Every hour maternal vital signs, visual analog scale (VAS) pain score, sensory levels, and motor block (Bromage score) were assessed. Data were expressed as mean ± 1 SD and analyzed using Chi -Squared and Mann-Whitney U tests at < 0.05. Results:The onset times were 10.62 ± 4.9 and 11.3 ± 4.7 min for the bupivacaine and ropivacaine groups respectively (P = NS). The median VAS scores were not different between the groups at any of the evaluation periods. However, at least 80% of patients in the ropivacaine group had no demonstrable motor block after the first hour compared with only 55% of patients given bupivacaine (P =0.01).Conclusions: Both bupivacaine and ropivacaine produce satisfactory labour analgesia. However, ropivacaine infusion is associated with less motor block throughout the first stage of labour and at 10 cm dilatation.Objectif : Comparer l'efficacité analgésique des perfusions de ropivacaïne-fentanyl et de bupivacaïne-fentanyl pour l'analgésie péridurale pendant le travail obstétrical.Méthode : Cent femmes nullipares et à terme ont été recrutées pour participer à une étude randomisée et à double insu. L'analgésie péridurale lombaire (APL) a été amorcée quand la dilatation cervicale était < 5 cm en utilisant soit de la bupivacaïne à 0,25 % suivie de bupivacaïne à 0,125 % + une perfusion à 2 µg·ml-1 de fentanyl (n=50), soit de la ropivacaïne à 0,2 % suivie de ropivacaïne à 0,1 % + une perfusion à 2 µg·ml-1 de fentanyl (n=50). On a noté à toutes les heures : les signes vitaux de la mère, les scores de douleur à l'échelle visuelle analogique (EVA), les niveaux sensitifs et le bloc moteur (score de Bromage). Les données ont été exprimées en termes de moyenne ± un écart type et analysées d'après le test Chi 2 et le test U de Mann-Whitney à <0,05.Résultats : Les délais d'installation ont été de 10,62 ± 4,9 et de 11,3 ± 4,7 min pour la bupivacaïne et la ropivacaïne respectivement (P = NS). Les scores moyens de l'EVA n'ont pas affiché de différence intergroupe. Cependant, au moins 80 % des patientes qui ont reçu de la ropivacaïne n'avait pas de bloc moteur vérifiable après la première heure contrairement à 55 % seulement des patientes à qui on a donné de la bupivacaïne (P =0,01).Conclusion : La bupivacaïne et la ropivacaïne produisent une analgésie satisfaisante pendant le travail obstétrical. La perfusion de ropivacaïne est toutefois associée à un bloc moteur moins intense pendant la première phase du travail et à 10 cm de dilatation.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125% — fentanyl infusions for epidural labour analgesia

Finegold

Mandell

Ramanathan

2000

Can J Anesth/J Can Anesth

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“…Individual patient outcomes were categorized as success, failure, or rejection, similar to previous minimal local analgesic concentration (MLAC) [12] and minimal analgesic dose (MAD) [33] methodologies. The MLAC methodology has been extensively used in obstetric anesthesia investigations to assess differences in potencies and analgesic responses both to opioids and local anesthetics [1,6,12,13,31,[36][37][38]39,40,41]. We used the same criteria to define successful analgesia or failure as those used in previous studies assessing median effective doses of opioids or local anesthetics, as indicated below:…”

Section: Initial Sequential Allocation Studymentioning

confidence: 99%

Genetic variability of the μ-opioid receptor influences intrathecal fentanyl analgesia requirements in laboring women ☆

Landau

Kern

Columb

et al. 2008

Pain

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136

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Labor initiates one of the most intensely painful episodes in a woman's life. Opioids are used to provide analgesia with substantial interindividual variability in efficacy. μ-Opioid receptor (μOR, OPRM1) genetic variants may explain differences in response to opioid analgesia. We hypothesized that OPRM1 304A/G polymorphism influences the median effective dose (ED 50 ) of intrathecal fentanyl via combined spinal-epidural for labor analgesia. Nulliparous women were prospectively recruited around 35 weeks gestation (n = 224), and genotyped for 304A/G polymorphism. Those requesting neuraxial labor analgesia were enrolled in one of the two double-blinded trials: up-down sequential allocation (SA, n = 50) and a separate confirmatory random-dose allocation trial (RA, n = 97). Effective analgesia from intrathecal fentanyl was defined by ⩾ 60 min analgesia with verbal rating score ≤1 (scale 0-10) and was compared between μOR 304A homozygotes (Group A) and women carrying at least one 304G allele (Group G). OPRM1 304G allele frequency f(−) was 0.18. Using SA, intrathecal fentanyl ED 50 was 26.8 μg (95% CI 22.7-30.9) in Group A and 17.7 μg (95% CI 13.4-21.9) in Group G (p < 0.001; 304A homozygosity increased the ED 50 1.5-fold). RA confirmed that 304A homozygosity significantly increases intrathecal fentanyl ED 50 (27.4 μg in Group A and 12.8 μg in Group G [p < 0.002; 2.1-fold]). We demonstrate for the first time that the μOR 304G variant significantly reduces intrathecal fentanyl ED 50 for labor analgesia, suggesting women with the G variant may be more responsive to opioids and require less analgesic drugs. These Conflict of interestNone of the authors presents any commercial association or other issues that might pose a conflict of interest. Financial disclosures

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“…Inconsistent findings have been reported in studies comparing the clinical effectiveness of ropivacaine and bupivacaine. Studies of local analgesic concentration have concluded that epidural ropivacaine may be 60% less potent than bupivacaine during early labor 31,32 . During orthopaedic procedures involving the lower limb, however, both bupivacaine and ropivacaine regional blocks have been demonstrated to be equally effective for controlling postoperative pain [33][34][35] .…”

mentioning

confidence: 99%

The Efficacy of Intra-Articular Injections for Pain Control Following the Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures

Georgopoulos

Carry

Pan

et al. 2012

The Journal of Bone and Joint Surgery-American Volume

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Relative Analgesic Potencies of Ropivacaine and Bupivacaine for Epidural Analgesia in Labor: Implications for Therapeutic Indexes

Cited by 84 publications

References 0 publications

Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125% — fentanyl infusions for epidural labour analgesia

Comparison of ropivacaine 0.1%-fentanyl and bupivacaine 0.125% — fentanyl infusions for epidural labour analgesia

Genetic variability of the μ-opioid receptor influences intrathecal fentanyl analgesia requirements in laboring women ☆

The Efficacy of Intra-Articular Injections for Pain Control Following the Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures

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