The Relative Motor Blocking Potencies of Epidural Bupivacaine and Ropivacaine in Labor

Lacassie, Héctor J.; Columb, Malachy O.; Lacassie, Hector P.; Lantadilla, Rodrigo A.

doi:10.1097/00000539-200207000-00036

Cited by 72 publications

(46 citation statements)

References 8 publications

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“…10 We used fentanyl in a concentration of 2 μg/ml as it was used most commonly in previous studies. Motor block from local anaesthetic can be minimized either by reducing the concentration of the local anaesthetic or by choosing a local anaesthetic with a high differential sensory: motor block ratio, such as Ropivacaine 11 The advantage of using a low concentration of local anaesthetic was well demonstrated in Comparative Obstetric Mobile Epidural Trial (COMET). 12 This showed that the instrumental vaginal delivery rate was less frequent when a low dose epidural regimen (Bupivacaine 0.1% with Fentanyl 0.0002%) was compared with a traditional epidural regimen (Bupivacaine 0.25%).In the present study 10 ml of 0.125% of Ropivacaine and 10 ml of 0.125% Bupivacaine with 2 mcg/ml of fentanyl are used for initiation and then 6-8 ml of the study drugs are used for maintenance.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of 0.125% Ropivacaine With Fentanyl 2 McG/Ml Versus 0.125% Bupivacaine With Fentanyl 2mcg/Ml for Labour Epidural Analgesia

Balasubramanyam¹,

Jamuna²,

Reddy³

2018

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BACKGROUNDThis study was undertaken to determine whether epidural analgesia is superior to all methods of pain relief for labour. Previous studies compared different concentrations of local anaesthetics epidurally with or without additives. Here ropivacaine is compared because, it is a new long acting amide local anaesthetic agent which is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in relatively reduced motor blockade. The reduced lipophilicity is associated with decreased potential of central nervous system toxicity and cardiotoxicity. Because of its favourable pharmacokinetic profile, the ropivacaine is chosen for labour epidural in comparison with bupivacaine. Aims and Objectives-to compare smaller concentration of epidural ropivacaine with bupivacaine in intermittent doses for obstetric analgesia by adding fentanyl to ropivacaine and bupivacaine solutions.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study of 0.125% Ropivacaine With Fentanyl 2 McG/Ml Versus 0.125% Bupivacaine With Fentanyl 2mcg/Ml for Labour Epidural Analgesia

Balasubramanyam¹,

Jamuna²,

Reddy³

2018

jebmh

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“…[13][14][15] Data from epidural motor block and intrathecal analgesia studies have emerged the potency hierarchy as bupivacaine>levobupivacaine>ropivacaine. [2][3][4][5]16 In another study, adding sufentanil to 0.25% bupivacaine provided rapid onset of analgesia and prolonged the duration of analgesia, but the qual- Values were presented as n(%).…”

Section: Discussionmentioning

confidence: 99%

“…Sufentanil is the most potent opioid. [2][3][4][5][6][7] Bupivacaine and sufentanil are frequently used together. 1,[8][9][10] However, the lowest doses that produce effective analgesia is still controversial.…”

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confidence: 99%

Comparison of Two Different Bupivacaine Doses with Sufentanil for Epidural Obstetric Analgesia

Çakirca¹,

Bektaş²,

Özcan³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : Addition of opioids to local anesthetics for epidural obstetric analgesia provides effective analgesia with decreased side effects. We compared the analgesic quality of 0,0625% bupivacaine and 0,1% bupivacaine with 0.5 μg/mL sufentanil. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Study participants were 18-45-year-old, primiparous 30 parturients. An epidural catheter was placed, 8-10 mL of 0.0625% bupivacaine with 0.5 μg/mL sufentanil and 0.1% bupivacaine with 0.5 μg/mL sufentanil were given to Group I and Group II, respectively. Hemodynamic parameters, obstetric examination findings, pain grades, time to reach visual analog scale (VAS)<4 and the first dose interval were recorded. Satisfaction levels, motor and sensorial blocks, oxytocin and valetamate bromide consumption, side effects were assessed. Total and additional drug use, duration of second stage of the delivery, mean delivery times, instrumental delivery, Apgar scores, fetal heart rates and uterine contraction pressures were recorded. The percentage of participation of the parturients to the delivery was assessed. R Re es su ul lt ts s: : Median VAS values were significantly lower in Group II. Median VAS values were lower than 4 in both groups after 15 th minute. The time to the second analgesic dose was longer in Group II. Systolic, diastolic and mean arterial blood pressures were measured lower in Group II. Satisfaction scores were significantly higher in Group II. C Co on nc cl lu us si io on n: : In the present study, satisfactory analgesia was produced in both groups. Although median VAS scores were lower in Group II, VAS<4 could be reached in Group I. We concluded that 0.0625% bupivacaine+0.5 μg/mL sufentanil combination, as providing VAS<4, could be a preferable alternative to 0.1% bupivacaine+0.5 μg/mL sufentanil. K Ke ey y W Wo or rd ds s: : Analgesia, obstetrical; analgesia, epidural Ö ÖZ ZE ET T A Am ma aç ç: : Epidural obstetrik analjezi için lokal anesteziklere opioidlerin eklenmesi daha efektif bir analjezi sağlar ve yan etkileri azaltır. Biz bu çalışmada %0,0625 bupivakain ve %0,1 bupivakaine 0,5 mikrog/mL sufentanil ekleyerek analjezi kalitesini karşılaştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya, 18-45 yaşları arasında, 30 primipar gebe dahil edildi. Epidural kateter yerleştirildikten sonra %0,0625 bupivakain ile 0,5 mikrog/mL sufentanil veya %0,1 bupivakain ile 0,5 mikrog/mL sufentanil sırasıyla Grup I ve Grup II olarak belirlendi ve 8-10 mL uygulandı. Hemodinamik parametreler, obstetrik muayene bulguları, ağrı düzeyleri, vizuel analo skala (VAS)<4 olma zamanı ve ilk analjezik gereksinim zamanı kayıt edildi. Memnuniyet dereceleri, motor ve duyusal blok, oksitosin ve valetamat bromür kullanımı ve yan etkiler değerlendirildi. Toplam ve ek ilaç kullanımı, doğumun 2. evresinin süresi, doğumun toplam süresi, doğumda yardımcı alet kullanımı, Apgar skorları, fetal kalp hızı ve uterin kontraksiyon basınçları kayıt edildi. Gebelerin doğuma katılı...

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“…However, it does not estimate the volumes of local anesthetics necessary to promote anesthesia in 95% and 99% of the patients, which would be clinically more relevant 23 . For this reason, Probit regression was used to calculate the estimated volumes of anesthetic effective in 95% and 99% of the patients 24 . Both methods use normal distribution to estimate the effective volumes.…”

Section: Discussionmentioning

confidence: 99%

Volumes anestésicos efetivos no bloqueio do nervo isquiático: comparação entre as abordagens parassacral e infraglútea-arabiceptal com bupivacaína a 0,5% com adrenalina e ropivacaína a 0,5%

Helayel¹,

Conceição²,

Knaesel³

et al. 2009

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:O volume e a massa das soluções de anestésico local (AL) influenciam a taxa de sucesso dos bloqueios periféricos. Desta forma, o objetivo principal do estudo foi determinar os volumes de anestésico local para o bloqueio do nervo isquiático (BNI) nas abordagens parassacral e infraglútea-parabiceptal. MÉTODO:Cento e um pacientes foram alocados aleatoriamente em 4 grupos e submetidos ao BNI nas abordagens infraglútea-parabiceptal ou parassacral, utilizando ropivacaína a 0,5% ou bupivacaína a 0,5% com adrenalina 5 µg.mL -1 . Sucesso foi definido como bloqueio sensitivo e motor completo do nervo isquiático 30 minutos após a injeção do AL. Os volumes foram calculados pelo método upand-down. RESULTADOS:Na abordagem parassacral o volume efetivo médio da ropivacaína foi 17,6 mL (IC 95%: 14,9 -20,8) e da bupivacaína 16,4 mL (IC 95%: 12,3 -21,9). Na abordagem infraglútea-parabiceptal o volume efetivo médio da ropivacaína foi 21,8 mL (IC 95%: 18,7 -25,5) e bupivacaína 20,4 mL (IC 95%: 18,6 -22,5). Volumes foram significativamente menores (p < 0,01) na abordagem parassacral comparativamente à infraglútea-parabiceptal. Na estimativa da regressão de Probits para volumes efetivos em 95% dos pacientes, os volumes na abordagem parassacral foram 21,8 mL para ropivacaína e 20,5 mL para bupivacaína; e na infraglútea-parabiceptal foram 27,2 mL na ropivacaína e 25,5 mL na bupivacaína. O volume efetivo em 99% dos pacientes no BNI parassacral para ropivacaína foi 24 mL e para bupivacaína 22,5 mL; e 29,9 mL de ropivacaína e 28,0 mL de bupivacaína no grupo infraglúteo-parabiceptal. CONCLUSÕES:Foram necessários volumes significativamente menores na abordagem parassacral do BNI comparativamente à abordagem infraglútea-parabiceptal, mas os volumes anestésicos não diferiram entre os AL.Unitermos: ANESTÉSICO, LOCAL: bupivacaína; ropivacaína; TÉCNICAS ANESTÉSICAS, Regional: bloqueio do nervo isquiático. SUMMARY BACKGROUND AND OBJECTIVES:The volume and mass of local anesthetics (LA) affect the success rate of peripheral nerve blocks. Thus, the main objective of this study was to determine the volumes of local anesthetics in parasacral and infragluteal-parabiceps sciatic nerve block (SNB). METHODS:One hundred and one patients undergoing infragluteal-parabiceps or parasacral SNB with 0.5% ropivacaine or 0.5% bupivacaine with 5 µg.mL -1 of adrenaline were randomly divided into 4 groups. Success was defined as complete sensitive and motor blockades of the sciatic nerve 30 minutes after the administration of the LA. Volumes were calculated by the up-and-down method. RESULTS:In the parasacral approach, the mean effective volume of ropivacaine was 17.6 mL (95% CI: 14.9-20.8) and of bupivacaine it was 16.4 mL (95% CI: 12.3-21.9). In the infragluteal-parabiceps approach, the mean effective volume of ropivacaine was 21.8 mL (95% CI: 18.7-25.5), and that of bupivacaine was 20.4 mL (95% CI: 18.6-22.5). Volumes were significantly lower (p < 0.01) in the parasacral than in the infragluteal-parabiceps approach. In Probit regression, ...

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The Relative Motor Blocking Potencies of Epidural Bupivacaine and Ropivacaine in Labor

Abstract: The results of this study demonstrate that epidural ropivacaine is less potent than epidural bupivacaine in producing motor blockade during labor. The motor block potency relation is similar to the sensory potency ratio for these two drugs.

Cited by 72 publications

References 8 publications

A Comparative Study of 0.125% Ropivacaine With Fentanyl 2 McG/Ml Versus 0.125% Bupivacaine With Fentanyl 2mcg/Ml for Labour Epidural Analgesia

A Comparative Study of 0.125% Ropivacaine With Fentanyl 2 McG/Ml Versus 0.125% Bupivacaine With Fentanyl 2mcg/Ml for Labour Epidural Analgesia

Comparison of Two Different Bupivacaine Doses with Sufentanil for Epidural Obstetric Analgesia

Volumes anestésicos efetivos no bloqueio do nervo isquiático: comparação entre as abordagens parassacral e infraglútea-arabiceptal com bupivacaína a 0,5% com adrenalina e ropivacaína a 0,5%

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