Ropivacaine, fentanyl combo better than bupivacaine combo for labor analgesia

A new study published in the Indian Journal of Clinical Anaesthesia has reported that Ropivacaine provided effective analgesia with a faster onset of sensory block in comparison to bupivacaine and is safe for mother and fetus.

Of the various methods of labor analgesia, local anesthetics and opioids via epidural give the most effective analgesia. Local anesthetics used must have a rapid onset, long duration of action, no motor blockade and should be safe for both mother and baby.

Dr. Rakhee and associates conducted a randomized double-blind study with the objective of comparing the onset of sensory block, analgesic efficacy, motor blockade and maternal and neonatal outcome of ropivacaine in contrast to bupivacaine. Parturients with bleeding disorders decreased platelet count, infection at the site of injection and spinal column anomalies were excluded.

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Hence 60 parturients of the age group 20-40yrs and physical status of ASA II chosen for the study were randomly divided into 2 groups of 30 each. Group R received 5 ml 0.2% ropivacaine with 50mcg Fentanyl as bolus, followed by continuous infusion of ropivacaine 0.1% with Fentanyl 1 mcg/ml at 6 ml/hr. Group B received 5 ml 0.125% bupivacaine with 50 mcg Fentanyl as a bolus, followed by continuous infusion of bupivacaine 0.0625% with Fentanyl 1 mcg/ml at 6 ml/hr.

The investigators found that there was a significantly faster onset of sensory block with ropivacaine compared to bupivacaine (5.67 min versus 6.67min). Motor block was not observed in both the groups studied.

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“In our study, there was no motor block in both the groups which might explain the similar mode of delivery,” write the authors.

The study concluded that Ropivacaine (0.2% with 50 µg Fentanyl bolus followed by 0.1% with Fentanyl as continuous infusion) provides faster onset of sensory block compared to bupivacaine (0.125% with 50 µg Fentanyl bolus followed by infusion 0.0625% with Fentanyl), both providing effective analgesia and comparable obstetric outcome and was found to be safe for the mother and neonate.

For full information log on to 10.18231/2394-4994.2018.0115