NEONATAL OUTCOME AND MODE OF DELIVERY AFTER EPIDURAL ANALGESIA FOR LABOR WITH ROPIVACAINE AND BUPIVACAINE - A PROSPECTIVE METAANALYSIS

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.