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VOLUME 2 , ISSUE 2 ( April-June, 2017 ) > List of Articles

ORIGINAL ARTICLE

Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study

Malti Agrawal, Yogesh K Sharma

Citation Information : Agrawal M, Sharma YK. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017; 2 (2):73-77.

DOI: 10.5005/jp-journals-10050-10080

License: CC BY 3.0

Published Online: 01-12-2012

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Introduction

Combined spinal–epidural analgesia to provide pain relief in labor has become the technique of choice. It provides benefits of both spinal analgesia and flexibility of an epidural catheter. In this study, we compared levobupivacaine with fetanyl and ropivacaine with fentanyl in terms of onset and duration of sensory blockade.

Materials and methods

This was a double-blind randomized study on 60 parturients of American Society of Anesthesiologists status 1 and 2, all primipara with singleton pregnancy in active labor, were allocated randomly into two groups of 30 each. Group L received 3 mg of levobupivacaine intrathecally with 25 µg fentanyl followed by epidural top-ups of 14 mL levobupivacaine 0.125% with fentanyl 30 µg, whereas group R received 4 mg of ropivacaine intrathecally with 25 µg of fentanyl followed by epidural top-ups of 14 mL ropivacaine 0.2% with fentanyl 30 µg. Sensory and motor characteristics, hemodynamics, maternal and fetal outcomes, side effects, and complications were observed and analyzed statistically using Student's unpaired t-test and chi-squared test.

Results

A rapid onset of analgesia in group L (4.67 ± 0.35) as compared with group R (5.57 ± 0.27) was observed. Duration of analgesia was also prolonged in group B (116.83 ± 6.91) as compared with group R (88.87 ± 5.10). Patients remained hemodynamically stable, and side effects and complications were comparable in both groups.

Conclusion

Levobupivacaine with fentanyl combination was found to be more promising in terms of onset and duration of labor analgesia as compared with ropivacaine and fentanyl combination.

How to cite this article

Sharma YK, Agrawal M. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017;2(2):73-77.


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  1. The myth of painless childbirth (the John J. Bonica lecture). Pain 1984 Aug;19(4):321-337.
  2. Maternal catecholamines decrease during labor after lumbar epidural anaesthesia. Am J Obstet Gynaecol 1983 Sep 1;147(1):13-15.
  3. Comparison of low-dose epidural with combined spinal-
epidural analgesia for labor. Br J Anaesth 1999 Nov;83(5): 756-760.
  4. Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effects on maternal satisfaction. Br Med J 1991 Mar 9;302(6776):564-567.
  5. Comparison of bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl for epidural analgesia during labor. Eur J Anaesthesiol 2002 Apr;19(4):263-270.
  6. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine and ropivacaine in anaesthetized swine. Anaesth Analg 2000 Jun;90(6):1308-1314.
  7. Randomized comparison of combined spinal-epidural and standard epidural analgesia in labor. Lancet 1995 Jun 3;345(8962):1413-1416.
  8. Acute pain-labor analgesia. Indian J Anaesth 2006;50(5):363-369.
  9. Comparison among intrathecal fentanyl, meperidine and sufentil for labor analgesia. Anaesth Analg 1992 Nov;75(5):734-739.
  10. The dose-response relation of intrathecal fentanyl for labor analgesia. Anaesthesiology 1998 Feb;88(2):355-361.
  11. A comparison of median effective doses of intrathecal levobupivacaine and ropivacaine for labor analgesia. Anaesthesiology 2005 Mar;102(3):651-656.
  12. Obstet Gynaecol 2004 Jul;104(1):213.
  13. Posterior column sensory impairment during ambulatory ectradural analgesia in labor. Br J Anaesth 1994 Oct;73(4):540-542.
  14. Epidural infusion of low dose bupivacaine and opioid in labor. Does reducing motor block increase the spontaneous delivery rate. Anaesthesia 1996 Mar;51(3):266-273.
  15. Cardiac arrest following regional anaesthesia with etidocaine or bupivacaine. Anaesthesiology 1979 Oct;51(4):285-287.
  16. Comparative evaluation of intrathecal administration of newer local anaesthetic agents ropivacaine and levobupivacaine with bupivacaine in patients undergoing lower limb surgery. Internet J Anaesthesiol 2007;17(1):11.
  17. Comparison of clinically relevant doses of intrathecal ropivacaine and levobupivacaine with fentanyl for labor analgesia. Korean J Anaesthesiol 2013 Dec;65(6):525-530.
  18. Comparison of patient-controlled epidural bolus administration of 0.1% ropivacaine and 0.1% levobupivacaine, both with 0.0002% fentanyl, for analgesia during labour. Anaesthesia 2004 Feb;59(2):133-137.
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