Gc. Meister et al., A comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labor, ANESTH ANAL, 90(3), 2000, pp. 632-637
Citations number
17
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
We previously found that the extent of an epidural motor block produced by
0.125% ropivacaine was clinically indistinguishable from 0.125% bupivacaine
In laboring patients. By adding fentanyl to the 0.125% ropivacaine and bup
ivacaine solutions in an attempt to reduce hourly local anesthetic requirem
ents, we hypothesized that differences in motor block produced by the two d
rugs may become apparent. Fifty laboring women were randomized to receive e
ither 0.125% ropivacaine with fentanyl 2 mu g/mL or an equivalent concentra
tion of bupivacaine/fentanyl using patient-controlled epidural analgesia (P
CEA) with settings of: 6-mL/hr basal rate, 5-mL bolus, 10-min lockout, 30-m
L/h dose limit. Analgesia, local anesthetic use, motor block, patient satis
faction, and side effects were assessed until the time of delivery. No diff
erences in verbal pain scores, local anesthetic use, patient satisfaction,
or side effects between groups were observed; however, patients administere
d ropivacaine/fentanyl developed significantly less motor block than patien
ts administered bupivacaine/fentanyl. Ropivacaine 0.125% with fentanyl 2 mu
g/mL produces similar labor analgesia with significantly less motor block
than an equivalent concentration of bupivacaine/fentanly. Whether this stat
istical reduction in motor block improves clinical outcome or is applicable
to anesthesia practices which do not use the PCEA technique remains to be
determined. Implications: By using a patient-controlled epidural analgesia
technique, ropivacaine 0.125% with fentanyl 2 mu g/mL produces similar anal
gesia with significantly less motor block than a similar concentration of b
upivacaine with fentanyl during labor. Whether this statistical reduction i
n motor block improves clinical outcome or is applicable to anesthesia prac
tices which do not use the patient-controlled epidural analgesia technique
remains to be determined.