Key result
Ropivacaine 0.2% with fentanyl provided a significantly faster onset of epidural labor analgesia compared to ropivacaine 0.125% with fentanyl (5.50 vs 11.25 minutes).
Why the study?
Ropivacaine produces less motor block than other local anesthetics, but the optimal concentration for sensory and motor block characteristics when combined with fentanyl in epidural labor analgesia needed evaluation.
Does 0.2% ropivacaine compared to 0.125% ropivacaine (both with fentanyl) improve the onset and duration of epidural labor analgesia in nulliparous women?
Does 0.2% ropivacaine compared to 0.125% ropivacaine (both with fentanyl) improve the onset and duration of epidural labor analgesia in nulliparous women?
Absolute Event Rate: 5.5% vs 11.25%
p-value: p=<0.05
Both 0.125% and 0.2% ropivacaine with fentanyl provide effective epidural labor analgesia, but 0.2% ropivacaine offers a significantly faster onset of pain relief.
Both concentrations effective for labor epidural analgesia; leaves open optimal dosing pending randomized confirmation of onset and duration differences.
Background: Ropivacaine is more selective for sensory fibers when compared to other local anesthetics, producing less motor block. This permits better maternal ambulation and also allows for normal progression of labor, which translates into lesser instrumental deliveries and higher vaginal deliveries. Objective was to evaluate 0.125% versus 0.2% ropivacaine, with 2 μg/ml of fentanyl in epidural labor analgesia, regarding their sensory and motor block characteristics.Methods: This prospective study was conducted among 40 patients, 20 in each group [group A (0.125% ropivacaine with 2 µg/ml fentanyl), group B (0.2% ropivacaine with 2 µg/ml fentanyl)], for epidural labor analgesia in obstetrics and gynecology department (labor room). The efficacy of the drugs was tested by comparing the onset of analgesia, duration of labor analgesia, dose requirement, pulse, BP, sensory effect, motor effect, FHR, APGAR score and side effects.Results: Total duration of labor analgesia was 230.25 minutes with 55.68 SD and 186.25 minutes with 57.7 SD in group A and group B respectively (p<0.05). The total dose of ropivacaine used was 81.00 mg and 68.50 mg in group A and B respectively (p<0.05). Total dose of fentanyl required was 94.50 µg and 73.50 µg in group A and group B respectively (p<0.05). There was no significant difference found in hemodynamic parameters in both groups.Conclusions: Both the concentrations are effective in producing epidural labor analgesia. However, onset of analgesia was significantly faster with 0.2% ropivacaine. The required dose of ropivacaine was significantly higher in 0.125% ropivacaine. 0.2% ropivacaine shorten the duration of labor compared to 0.125% ropivacaine.
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Patel et al. (2022) studied Labor pain (n=40). Ropivacaine 0.2% with fentanyl vs. 15 ml of 0.125% ropivacaine with 2 µg/ml fentanyl was evaluated on Onset of analgesia (minutes) (p=<0.05). Ropivacaine 0.2% with fentanyl provided a significantly faster onset of epidural labor analgesia compared to ropivacaine 0.125% with fentanyl (5.50 vs 11.25 minutes).
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