Ropivacaine 2 mg/mL vs. bupivacaine 1.25 mg/mL with sufentanil using patient‐controlled epidural analgesia in labour

Abstract

The results support the findings of previously published studies postulating ropivacaine to be 40-50% less potent for labour epidural analgesia compared to bupivacaine. However, we observed an increased frequency of instrumental deliveries with ropivacaine. To evaluate the clinical relevance of these findings, further investigations are warranted.

Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis

“…Ten studies 11,12,[15][16][17][18][19][20][21][22] were finally selected by following inclusion and exclusion criteria. The study screening and selection process is depicted in Figure 1 and the characteristics of the included studies including patients' demographic and obstetric data, and concentration of anesthetics used in each study is presented in Table 2.…”

“…Whereas Buyse et al 15 have shown that the dose sparing effect of sufentanil is greater for bupivacaine (up to 90%) than for ropivacaine or levobupivacaine (up to 78%), van de Velde et al 11 in a dose-response study noticed that in combination with sufentanil, racemic bupivacaine is more potent than ropivacaine (1.4 times) and levobupivacaine (1.5 times) with ED95 of ropivacaine and levobupivacaine of 4.8 mg (95% CI, 4.0-6.7) and 5.0 mg (95% CI, 4.1-7.0), respectively. Wang et al 12 have calculated the EC50 and EC95 by using probit regression as: 0.044% (0.031%-0.056%) and 0.177% (0.138%-0.261%) for bupivacaine, 0.053% (0.039%-0.066%) (a) Clement et al 17 Fischer et al 18 Gautier et al 19 Gogarten et al 20 Hoffman-kiefer et al 21 Van de Velde et al 11 17 Fischer et al 18 Gautier et al 19 Gogarten et al 20 Hoffman-kiefer et al 21 Van de Velde et al 11 and 0.214% (0.165%-0.328%) for ropivacaine, and 0.052% (0.038%-0.064%) and 0.210% (0.164%-0.320%) for levobupivacaine, respectively.…”

“…Fischer et al 18 Gogarten et al 20 Hoffman-kiefer et al 21 For many parameters, the number of studies providing data was low and this was more important in BUPI-SUF vs LBUPI-SUF comparisons. Fewer studies were found in the literature search for a period of about 15 years and a moderate level of publication bias was also evident from visual examination of the funnel plot ( Figure 6).…”

“…Buyse et al 15 Carmorcia & Capogna 16 Clement et al 17 Fischer et al 18 Gautier et al 19 Gogarten et al 20 Hoffman-kiefer et al 21 Merson 22 Van de Velde et al 11 Buyse et al 15 Carmorcia & Capogna 16 Clement et al 17 Fischer et al 18 Gautier et al 19 Gogarten et al 20 Hoffman-kiefer et al 21 Merson 22 Van de Velde et al 11 Wang et al 12 Total events Heterogeneity: Tau Buyse et al 15 Carmorcia & Capogna 16 Van de Velde et al 11 Wang As ropivacaine has been found to possess lower potency (up to 40% less) compared to racemate bupivacaine 11 , there arose the important question of whether the lower incidence of motor blocks in ropivacaine anesthetized patients is merely because of its lower potency. Gautier et al 19 argued in favor of drug effect rather than potency.…”

Comparative efficacy of minimal concentration of racemic bupivacaine (0.0625%) with fentanyl and ropivacaine (0.1%) with fentanyl for epidural labor analgesia

“…Hoffmann-Kiefer et al . [ 25 ] observed that the mean total consumption was significantly more in ropivacaine group as compared to bupivacaine group.…”