Key result
The effective concentration of ropivacaine in 90% of patients (EC90) for maintaining the first stage of labor without breakthrough pain when combined with dexmedetomidine and programmed intermittent epidural bolus was 0.117%.
Why the study?
Data were limited regarding the administration of ropivacaine combined with dexmedetomidine for epidural analgesia during labor maintenance using the programmed intermittent epidural bolus technique.
Does varying the dose of ropivacaine with dexmedetomidine affect the incidence of breakthrough pain during labor maintenance in nulliparous parturients?
RCT (n=100)
Double-blind
Randomized into 4 groups
No
Does varying the dose of ropivacaine with dexmedetomidine affect the incidence of breakthrough pain during labor maintenance in nulliparous parturients?
Effect estimate: EC50 0.051% (95% CI 0.011-0.065)
Absolute Event Rate: 13% vs 55%
p-value: p=0.003
A ropivacaine dose of 0.117% combined with dexmedetomidine and the PIEB technique is estimated to provide effective epidural analgesia for labor maintenance in 90% of nulliparous parturients.
Supports 0.117% ropivacaine with dexmedetomidine for PIEB labor maintenance; extends dose-response evidence for epidural regimens in nulliparas.
Background: The combination of ropivacaine and dexmedetomidine has been used as an epidural analgesic for inducing labor. However, there is limited data regarding the administration of epidural analgesia for labor maintenance, hence, this study aimed to determine the optimum concentration through dose-response curves of ropivacaine plus dexmedetomidine, which could be used along with the Programmed Intermittent Epidural Bolus (PIEB) technique. Methods: One hundred parturients were randomized into 4 groups who were administered four different doses of ropivacaine (dexmedetomidine at 0.4 μg mL−1): 0.04%, 0.06%, 0.08%, and 0.1%. The primary outcome that was determined included the proportion of patients experiencing breakthrough pain during their 1st stage of labor. Breakthrough pain was described as a visual analog scale [VAS] score of >30 mm, requiring supplemental epidural analgesia after the administration of at least one patient-controlled bolus. The effective concentration of analgesia that was used for labor maintenance in 50% (EC50) and 90% (EC90) of patients were calculated with the help of probit regression. Secondary outcomes included epidural block characteristics, side effects, neonatal outcomes, and patient satisfaction. Results: The results indicated that the proportion of patients without breakthrough pain was 45% (10/22), 55% (12/22), 67% (16/24), and 87% (20/23) for 0.04%, 0.06%, 0.08%, and 0.10% doses of the analgesic that were administered, respectively. The EC50 value was 0.051% (95% confidence interval [CI], 0.011%–0.065%) while the EC90 value was recorded to be 0.117% (95% CI, 0.094%–0.212%). Side effects were similar among groups. Conclusion: A ropivacaine dose of 0.117% can be used as epidural analgesia for maintaining the 1st stage of labor when it was combined with dexmedetomidine (0.4 μg mL−1) and the PIEB technique. Clinical Trial Register: https://www.chictr.org.cn/index.aspx , identifier ChiCTR2200059557
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Shen et al. (2023) conducted an RCT in Labor pain in nulliparous parturients (n=100). Ropivacaine with dexmedetomidine vs. Different doses (0.04% as lowest dose reference) was evaluated on Proportion of patients experiencing breakthrough pain during the 1st stage of labor (EC50 0.051%, 95% CI 0.011-0.065, p=0.003). The effective concentration of ropivacaine in 90% of patients (EC90) for maintaining the first stage of labor without breakthrough pain when combined with dexmedetomidine and programmed intermittent epidural bolus was 0.117%.
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