Epidural administration of local anaesthetics, with or without opioids, is commonly used for the relief of pain in labor. Lower concentration of local anesthetics is used for providing labor epidural analgesia.
MATERIALS AND METHODS
After approval of the Institutional Ethical Committee, this study was conducted at a teaching hospital in GGH, Kakinada on 50 term parturients. 50 parturients of ASA I & II, primi or multi gravida with singleton pregnancy having vertex presentation were taken up for the study. They were randomly divided into 2 groups–Group R1 and Group R2 each comprising of 25 parturients. Study patients (n=50) were randomly assigned to one of two groups of 25 each. They received aliquots of epidural injection using either, 10 ml of ropivacaine 0.125 % with 2 μg/ml fentanyl (group R1) or 10 ml of ropivacaine 0.2% with 2 μg/ml fentanyl (group R2).
Demographic data, obstetric data, and injection delivery interval were comparable in both groups. Effective labor analgesia with no motor blockade was observed in both groups. Duration of analgesia after initial bolus dose was also significantly longer in group R2 (126.45 ± 12.34 min) than in group R1 (73.05±27.4min). Ropivacaine at both concentrations (0.2% vs. 0.125%) along with fentanyl 2μg / ml decreased visual analog scale (VAS) scores to <3 in all parturients uniformly. Mean VAS scores were significantly less in group R2 than in group R1 at 5,60, and 90 min. Requirement of top-up doses was significantly less in group R2 as compared to group R1. Consumption of ropivacaine was comparable in both the groups (58.23 ± 5.48 mg in group R1 and 65.88 ± 6.29 mg in group R2, but consumption of fentanyl was significantly more in group R1 (94.31 ± 4.93 mg) as compared to group R2 (31.58 ± 2.38 mg). There were no significant changes in haemodynamics, nor adverse effects related to neonatal or maternal outcomes in both groups.
We conclude that both the concentrations of ropivacaine (0.2% and 0.125%) with fentanyl were effective in producing epidural labor analgesia. 0.2% concentration was found superior in prolonging the duration, lesser breakthrough pain requiring lesser top-ups, and a lesser consumption of opioids. Our study favors, the use of 10ml of 0.2% ropivacaine with 2mcg/ml fentanyl over 0.125% ropivacaine for labor analgesia.