This Article Full Text Full Text (PDF) En Espanol Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (46) Citing Articles via Google Scholar Google Scholar Articles by Meister, G. C. Articles by Gaver, R. Search for Related Content PubMed PubMed Citation Articles by Meister, G. C. Articles by Gaver, R.

---

OBSTETRIC ANESTHESIA

A Comparison of Epidural Analgesia with 0.125% Ropivacaine with Fentanyl Versus 0.125% Bupivacaine with Fentanyl during Labor

Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Address correspondence and reprint requests to Robert D’Angelo, MD, Obstetric Anesthesia, Forsyth Medical Center, 3333 Silas Creek Pkwy., Winston-Salem, NC 27103. Address e-mail to rdangelo{at}wfubmc.edu

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 bupivacaine solutions in an attempt to reduce hourly local anesthetic requirements, we hypothesized that differences in motor block produced by the two drugs may become apparent. Fifty laboring women were randomized to receive either 0.125% ropivacaine with fentanyl 2 µg/mL or an equivalent concentration of bupivacaine/fentanyl using patient-controlled epidural analgesia (PCEA) with settings of: 6-mL/hr basal rate, 5-mL bolus, 10-min lockout, 30-mL/h dose limit. Analgesia, local anesthetic use, motor block, patient satisfaction, and side effects were assessed until the time of delivery. No differences in verbal pain scores, local anesthetic use, patient satisfaction, or side effects between groups were observed; however, patients administered ropivacaine/fentanyl developed significantly less motor block than patients administered bupivacaine/fentanyl. Ropivacaine 0.125% with fentanyl 2 µg/mL produces similar labor analgesia with significantly less motor block than an equivalent concentration of bupivacaine/fentanyl. Whether this statistical 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 µg/mL produces similar analgesia with significantly less motor block than a similar concentration of bupivacaine with fentanyl during labor. Whether this statistical reduction in motor block improves clinical outcome or is applicable to anesthesia practices which do not use the patient-controlled epidural analgesia technique remains to be determined.

This article has been cited by other articles:

				S. H. Halpern and B. Carvalho Patient-Controlled Epidural Analgesia for Labor Anesth. Analg., March 1, 2009; 108(3): 921 - 928. [Abstract] [Full Text] [PDF]

				I. Smet, E. Vlaminck, and M. Vercauteren Randomized controlled trial of patient-controlled epidural analgesia after orthopaedic surgery with sufentanil and ropivacaine 0.165% or levobupivacaine 0.125% Br. J. Anaesth., January 1, 2008; 100(1): 99 - 103. [Abstract] [Full Text] [PDF]

				Y. Beilin, N. R. Guinn, H. H. Bernstein, J. Zahn, S. Hossain, and C. A. Bodian Local Anesthetics and Mode of Delivery: Bupivacaine Versus Ropivacaine Versus Levobupivacaine Anesth. Analg., September 1, 2007; 105(3): 756 - 763. [Abstract] [Full Text] [PDF]

				K. M. Tran, T. J. Ganley, L. Wells, A. Ganesh, K. I. Minger, and G. Cucchiaro Intraarticular Bupivacaine-Clonidine-Morphine Versus Femoral-Sciatic Nerve Block in Pediatric Patients Undergoing Anterior Cruciate Ligament Reconstruction Anesth. Analg., November 1, 2005; 101(5): 1304 - 1310. [Abstract] [Full Text] [PDF]

				B. B. Lee, W. D. Ngan Kee, F. F. Ng, T. K. Lau, and E. L. Y. Wong Epidural Infusions of Ropivacaine and Bupivacaine for Labor Analgesia: A Randomized, Double-Blind Study of Obstetric Outcome Anesth. Analg., April 1, 2004; 98(4): 1145 - 1152. [Abstract] [Full Text] [PDF]

				J.-M. Bernard, D. Le Roux, and J. Frouin Ropivacaine and Fentanyl Concentrations in Patient-Controlled Epidural Analgesia During Labor: A Volume-Range Study Anesth. Analg., December 1, 2003; 97(6): 1800 - 1807. [Abstract] [Full Text] [PDF]

				M. W. Hollmann, K. Kurz, S. Herroeder, D. Struemper, K. Hahnenkamp, N. S. Berkelmans, C. G. den Bakker, and M. E. Durieux The Effects of S(-)-, R(+)-, and Racemic Bupivacaine on Lysophosphatidate-Induced Priming of Human Neutrophils Anesth. Analg., October 1, 2003; 97(4): 1053 - 1058. [Abstract] [Full Text] [PDF]

				L. S. Polley and M. O. Columb Ropivacaine and Bupivacaine: Concentrating on Dosing! Anesth. Analg., May 1, 2003; 96(5): 1251 - 1253. [Full Text] [PDF]

				S. H. Halpern and V. Walsh Epidural Ropivacaine Versus Bupivacaine for Labor: A Meta-Analysis Anesth. Analg., May 1, 2003; 96(5): 1473 - 1479. [Abstract] [Full Text] [PDF]

				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]

				M. Senard, J. L. Joris, D. Ledoux, P. J. Toussaint, B. Lahaye-Goffart, and M. L. Lamy A Comparison of 0.1% and 0.2% Ropivacaine and Bupivacaine Combined with Morphine for Postoperative Patient-Controlled Epidural Analgesia After Major Abdominal Surgery Anesth. Analg., August 1, 2002; 95(2): 444 - 449. [Abstract] [Full Text] [PDF]

				H. J. Clement, L. Caruso, F. Lopez, F. Broisin, M. Blanc-Jouvan, E. Derre-Brunet, A. Thomasson, G. Leboucher, and J. P. Viale Epidural analgesia with 0.15% ropivacaine plus sufentanil 0.5 {micro}g ml-1versus 0.10% bupivacaine plus sufentanil 0.5 {micro}g ml-1: a double-blind comparison during labour Br. J. Anaesth., June 1, 2002; 88(6): 809 - 813. [Abstract] [Full Text] [PDF]

				M. D. Owen, J. A. Thomas, T. Smith, L. C. Harris, and R. D'Angelo Ropivacaine 0.075% and Bupivacaine 0.075% with Fentanyl 2 {micro}g/mL are Equivalent for Labor Epidural Analgesia Anesth. Analg., January 1, 2002; 94(1): 179 - 183. [Abstract] [Full Text] [PDF]

				Y. Pouzeratte, J. M. Delay, G. Brunat, G. Boccara, C. Vergne, S. Jaber, J. M. Fabre, P. Colson, and C. Mann Patient-Controlled Epidural Analgesia After Abdominal Surgery: Ropivacaine Versus Bupivacaine Anesth. Analg., December 1, 2001; 93(6): 1587 - 1592. [Abstract] [Full Text] [PDF]

				A. J. Pinder, M. Dresner, R. D'Angelo, M. Owen, and K. Nelson Ropivacaine and Bupivacaine with Fentanyl for Labor Epidural Anesthesia Response Anesth. Analg., October 1, 2000; 91(5): 1310 - 1311. [Full Text] [PDF]

				L. S. Polley, M. O. Columb, R. D'Angelo, and M. D. Owen Potency, Impotency, and Importance! Response Anesth. Analg., September 1, 2000; 91(3): 765 - 766. [Full Text] [PDF]