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OBSTETRIC ANESTHESIA

Epidural Ropivacaine for the Initiation of Labor Epidural Analgesia: A Dose Finding Study

Yaakov Beilin, MD^*,, Mihai Galea, MD^*, Jeffrey Zahn, MD^*, and Carol A. Bodian, DrPH

Departments of *Anesthesiology, Obstetrics, Gynecology & Reproductive Sciences, and Biomathematical Sciences, Mount Sinai School of Medicine, New York, New York

Address correspondence and reprint requests to Yaakov Beilin, MD, Mount Sinai School of Medicine, Department of Anesthesiology, Box 1010, One Gustave L. Levy Place, New York, NY 10029-6574. Address e-mail to Ybeilin{at}smtplink.mssm.edu

The purpose of our study was to determine the lowest concentration of ropivacaine that offers pain relief for the initiation of labor epidural analgesia. Women in active labor were enrolled in this prospective, randomized, double-blinded study to receive either ropivacaine 0.20% (Group I), ropivacaine 0.15% (Group II), or ropivacaine 0.10% (Group III). After placement of the epidural catheter, 13 mL of the study medication was administered. Fifteen minutes later, the adequacy of analgesia was assessed. If the woman reported that her degree of analgesia was not adequate, an additional 5 mL of the study medication was given, the degree of pain relief was reassessed 15 min later, and the study was concluded. A sequential study design was used to assess the success rates. We found that 26 of 28 (93%) women in Group I had adequate analgesia, compared with only 18 of 28 (64%) in Group II (P = 0.014) and 4 of 12 (33%) in Group III (P = 0.003). We conclude that ropivacaine 0.20% offers adequate analgesia significantly more often than either ropivacaine 0.15% or ropivacaine 0.10%. If one selects ropivacaine as the sole local anesthetic for the initiation of labor epidural analgesia, the minimal concentration should be 0.20%.

Implications: The lowest effective concentration of ropivacaine for the initiation of labor epidural analgesia has not been determined. We found that ropivacaine 0.20% offers adequate analgesia significantly more often than either ropivacaine 0.15% or ropivacaine 0.10%. If one selects ropivacaine as the sole local anesthetic for the initiation of labor epidural analgesia, the minimal concentration should be 0.20%.

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				R. Landau, E. Schiffer, M. Morales, G. Savoldelli, and C. Kern The Dose-Sparing Effect of Clonidine Added to Ropivacaine for Labor Epidural Analgesia Anesth. Analg., September 1, 2002; 95(3): 728 - 734. [Abstract] [Full Text] [PDF]

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