Author(s): Vallem Balasubramanyam, Talisetti Jamuna, Vakkakula Kiran Reddy
This 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.
MATERIALS AND METHODS In this prospective randomised double-blind study, sixty women in labour were randomly allocated to receive either bupivacaine 0.125% with fentanyl 2 mcg/ml or ropivacaine 0.125% with fentanyl 2mcg/ml. visual analogue scale was used to test sensory block and pain respectively. Bromage scale was used to test motor block. Haemodynamic parameters, duration of labour, APGAR score for 1 and 5 minutes, dose requirement of drug to produce analgesia, incidence of side effects were also recorded. Data was expressed as mean ± standard deviation and analysed using students unpaired t test, chi square test at p-value <0.05.
RESULTS Regarding haemodynamic stability, onset of analgesia, quality of analgesia, sensory blockade, neonatal outcome, requirement of drugs, duration of labour and incidence of side effects both drugs showing similar results. Five parturients in bupivacaine group had a motor block of Bromage score 2 and were delivered with assistance. None of the parturients in ropivacaine group had any motor block and all had spontaneous vaginal delivery, but this difference was not statistically significant.
CONCLUSION Ropivacaine 0.125% with fentanyl 2mcg/ml produces similar analgesia with significantly less motor block than a similar concentration of bupivacaine with fentanyl during labour.