Labour Epidural Analgesia: A Randomised Double Blind Comparative Study of 0.1% Levobupivacaine with Fentanyl vs. 0.1% Ropivacaine with Fentanyl

Abstract

Introduction: Levobupivacaine and ropivacaine are suitable alternatives to bupivacaine for labour analgesia as they produce less motor blockade, decreased incidence of instrumental deliveries and less toxicity. Aim: To study the efficacy of epidural levobupivacaine and ropivacaine in intermittent doses for labour analgesia. Materials and Methods: In the present prospective, randomised, double blind study, 60 parturients consenting for labour epidural analgesia using intermittent top-up technique were randomly allocated to receive either levobupivacaine 0.1% with Fentanyl 2 mcg/mL (LF) or ropivacaine 0.1% with Fentanyl 2 mcg/mL (RF). Haemodynamic parameters, sedation score, onset and quality of analgesia, sensory and motor blockade, local anaesthetic requirement, side effects, duration of labour, mode of delivery, neonatal outcome and maternal satisfaction were compared between groups. Statistical analysis included students unpaired t-test, chi-square test, Fischer’s-exact test, Mann-Whitney U-test as appropriate with p<0.05 was considered statistically significant. Results: Demographic and obstetric parameters were comparable in two groups. Both drugs were comparable with respect to haemodynamics, sedation score, onset and quality of analgesia, sensory and motor blockade, local anaesthetic requirement, duration of labour, mode of delivery, neonatal outcome, maternal satisfaction and side effects. One parturient (3.33%) in RF group developed motor block of Bromage grade 1 as compared to none in LF group without any statistical significance. No parturient required Rescue analgesia. Conclusion: The combinations of low concentration (0.1%) of epidural levobupivacaine and ropivacaine with fentanyl provide equivalent labour analgesia, without significant maternal or fetal side effects.

Keywords

• anaesthetic drugs
• low concentration local anaesthetics
• opioids