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Anesth Analg 2007;105:756-763
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000278131.73472.f4

OBSTETRIC ANESTHESIOLOGY

Local Anesthetics and Mode of Delivery: Bupivacaine Versus Ropivacaine Versus Levobupivacaine

Yaakov Beilin, MD*{dagger}, Nicole R. Guinn, BS*, Howard H. Bernstein, MD*{dagger}, Jeff Zahn, MD*, Sabera Hossain, MS{ddagger}, and Carol A. Bodian, DrPH{ddagger}

From the Departments of *Anesthesiology, and {dagger}Obstetrics, Gynecology and Reproductive Sciences, and the {ddagger}Division of Biostatistics, Mount Sinai School of Medicine of New York University, New York, New York.

Address correspondence and reprint requests to Yaakov Beilin, MD, Department of Anesthesiology, The Mount Sinai Medical Center, Box 1010, One Gustave L. Levy Place, New York, NY 10029-6574. Address e-mail to yaakov.beilin{at}mountsinai.org.

Abstract

BACKGROUND: The influence of the labor epidural local anesthetic (LA) on mode of delivery has not been adequately studied. In this study, we sought to determine if there is a difference in mode of delivery among parturients who receive epidural bupivacaine, ropivacaine, or levobupivacaine.

METHODS: Nulliparous women at term requesting labor analgesia with a cervical dilation <5 cm were randomized to receive epidural bupivacaine, ropivacaine, or levobupivacaine. Analgesia was initiated with a bolus of 15 mL of 0.0625% of the assigned LA with fentanyl 2 µg/mL. Analgesia was maintained with an infusion of the same solution at 10 mL/h. The primary endpoint was the operative delivery rate (instrumental assisted vaginal delivery plus cesarean delivery).

RESULTS: Ninety-eight women received bupivacaine, 90 ropivacaine, and 34 levobupivacaine (before it was removed from the US market). There was no significant difference in the operative delivery rate (bupivacaine = 46%, ropivacaine = 39%, and levobupivacaine = 32%, P = 0.35) among groups. There was less motor block in the levobupivacaine group when compared with the ropivacaine and bupivacaine groups, P < 0.05. There was no significant difference in the duration of the first or second stage of labor, the total dose of LA received per hour of labor, or neonatal outcome among groups.

CONCLUSIONS: Bupivacaine, ropivacaine, and levobupivacaine all confer adequate labor epidural analgesia, with no significant influence on mode of delivery, duration of labor, or neonatal outcome.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.