0.5% ropivacaine with fentanyl in combined spinal epidural for labor analgesia: Comparison with 0.25% ropivacaine with fentanyl and 0.25% bupivacaine with fentanyl
Dr. S. Sivakumar, Dr. K. Harikaran, Dr. L. Sanjiv
Background: The pains of labor result in a maternal stress response, which is neither beneficial for the fetus nor the mother . Hence, maternal pain relief not only benefits the parturient, but her neonate also . Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labor and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety . Central neuraxial analgesia is the most versatile method of labour analgesia and the gold standard technique for pain control in obstetrics that is currently available . The availability of newer local anaesthetics like ropivacaine and levo-bupivacaine have contributed towards the increased maternal safety in terms of being less cardiotoxic after an inadvertent IV injection.
Materials and method: This Prospective, randomised comparative study was conducted in 60 ASA physical status I or II women with term pregnancy, single, vertex presentation in active labour (cervical dilatation 3-4 cm) requesting labour analgesia.
Result: VAS pain scores were significantly lower in group 3 than in group I and II at 5 min, 60 min and 90 min of the study period, P < 0.001. Parturient and anesthesiologists graded acceptance rate as either excellent or “good” in all groups. Neonatal outcome was favorable in both the groups (APGAR scores >7 at 1 and 5 min) with no side-effect.
Conclusion: The results from our study support that intra-thecal 5mg ropivacaine with fentanyl and ropivacaine epidural top-up is a suitable choice for labour analgesia. The addition of opiods is always necessary to achieve good analgesia, high maternal satisfaction and acceptable motor blockade.