Wdr. Writer et al., NEONATAL OUTCOME AND MODE OF DELIVERY AFTER EPIDURAL ANALGESIA FOR LABOR WITH ROPIVACAINE AND BUPIVACAINE - A PROSPECTIVE METAANALYSIS, British Journal of Anaesthesia, 81(5), 1998, pp. 713-717
In this prospective meta-analysis, we have evaluated the effect of epi
dural analgesia with ropivacaine for pain in labour on neonatal outcom
e and mode of delivery compared with bupivacaine. In six randomized, d
ouble-blind studies, 403 labouring women, primigravidae and multiparae
, received epidural analgesia with ropivacaine or bupivacaine 2.5 mg m
l(-1). The drugs were administered as intermittent boluses in four stu
dies and by continuous infusion in two. Apgar scores, neurological and
adaptive capacity scores (NACS), degree of motor block and mode of de
livery were recorded. The studies were designed prospectively to fit m
eta-analysis of the pooled results. Results showed similar pain relief
and consumption of the two drugs. In the vaginally delivered neonates
, NAGS scores were approximately equal for both groups at 2 h, but at
24 h there were fewer infants with NAGS less than 35 in the ropivacain
e compared with the bupivacaine group (2.8% vs 7.6%; P<0.05). Spontane
ous vaginal deliveries occurred more frequently overall with ropivacai
ne than with bupivacaine (58% vs 49%; P<0.05) and instrumental deliver
ies (forceps and vacuum extraction) less frequently (27% vs 40%; P<0.0
1), while the frequency of Caesarean section was similar between group
s. The intensity of motor block was lower with ropivacaine, There were
no significant differences in adverse events.