Why the study?
Does high concentration epidural levobupivacaine (1.136 mg/ml) improve analgesia compared to low concentration (0.568 mg/ml) in labouring primiparous women?
Does high concentration epidural levobupivacaine (1.136 mg/ml) improve analgesia compared to low concentration (0.568 mg/ml) in labouring primiparous women?
High-concentration epidural levobupivacaine provides more efficacious analgesia than low-concentration in labouring women without increasing side-effects.
Supports high-concentration levobupivacaine for labor epidurals; extends RCT evidence favoring optimized dosing in primiparas.
The effects of two different concentrations of epidural levobupivacaine were compared when used to provide analgesia for labour. Primiparous women in spontaneous uncomplicated labour were enrolled in a prospective, randomised and partially double-blinded study. The study solutions were either 0.568 mg x ml(-1) levobupivacaine (low concentration group) or 1.136 mg x ml(-1) levobupivacaine (high concentration group), with sufentanil 0.45 microg x ml(-1) added to both solutions. Epidural analgesia was initiated with 20 ml of the study solution, followed by a standardised algorithm of top-up bolus injections. Epidural analgesia was then continued by self-administered boluses of 5-ml plus a continuous infusion of 5 ml x h(-1). Analgesia was found to be more efficacious in the high-concentration group. The dose of levobupivacaine administered was higher and sometimes overstepping recommended limits in the high concentration group, but with no observed increase in side-effects. The choice between these two concentrations may still be made according to the patient's and the practitioner's preferences. The effects of an intermediate concentration should be studied in the future.
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Tixier et al. (2010) studied this question.
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