Key result
Epidural labor analgesia using 0.2% ropivacaine with fentanyl was superior to 0.125% ropivacaine with fentanyl, providing faster onset, prolonged duration, and lesser opioid consumption.
Why the study?
This study aimed to evaluate the efficacy of 0.125% versus 0.2% ropivacaine, both with fentanyl 2 ug/ml, to determine the minimum effective local anesthetic concentration for epidural labor analgesia with reduced opioid consumption.
Does 0.2% ropivacaine improve epidural labor analgesia and reduce opioid consumption compared to 0.125% ropivacaine in term parturients?
RCT (n=50)
randomly assigned
Does 0.2% ropivacaine improve epidural labor analgesia and reduce opioid consumption compared to 0.125% ropivacaine in term parturients?
For epidural labor analgesia, 0.2% ropivacaine with fentanyl provides superior analgesia with faster onset, longer duration, and less opioid consumption compared to 0.125% ropivacaine.
May support lower-concentration labor epidurals for opioid sparing; hypothesis-generating, needing RCTs before practice change.
Aim: The aim of this study was to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. Objective: Among various labor analgesic techniques, epidural analgesia is the most effective form of analgesia. This study aimed to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine, both with fentanyl 2 μg/ml for epidural labor analgesia. Materials and Methods: A total of 50 term parturients of American Society of Anesthesiologists physical status Grade I and II with vertex presentation in active labor were randomly assigned to two groups, Group R1 and Group R2, which received 10 ml of 0.125% ropivacaine with injection fentanyl 2 μg/ml and 10 ml of 0.2% ropivacaine with fentanyl 2 μg/ml, respectively, as an initial bolus dose and intermittent top-up doses epidurally. Characteristics of the block, onset and duration of analgesia, and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with the Visual Analog Scale score. The maternal and fetal outcomes were recorded. Results: Maternal demographic characteristics were comparable. Although both the concentrations are effective in providing optimal labor analgesia, decreasing the concentration of ropivacaine has resulted in an increased number of repetition of doses and thus an increased consumption of fentanyl. There were no significant differences between the two groups regarding motor block, hemodynamic, and neonatal outcomes. Conclusion: We conclude that 0.2% ropivacaine was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids. Hence, we conclude that the use of 0.2% ropivacaine is superior to 0.125% ropivacaine with fentanyl.
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Rapeti et al. (2021) conducted an RCT in Labor pain (n=50). 0.2% ropivacaine with fentanyl 2 μg/ml vs. 0.125% ropivacaine with fentanyl 2 μg/ml was evaluated on Efficacy of analgesia (onset, duration, and total analgesic requirements). Epidural labor analgesia using 0.2% ropivacaine with fentanyl was superior to 0.125% ropivacaine with fentanyl, providing faster onset, prolonged duration, and lesser opioid consumption.
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