Anesth Analg 2000;90:1384-1389
© 2000 International Anesthesia Research Society
OBSTETRIC ANESTHESIA
Ambulatory Labor Epidural Analgesia: Bupivacaine Versus Ropivacaine
David C. Campbell, MD, MSc, FRCPC,
Rhonda M. Zwack, MD,
Lesley-Ann L. Crone, MD, FRCPC, and
Ray W. Yip, MD, FRCPC
Department of Anesthesiology, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Address correspondence and reprint requests to David C. Campbell, MD, MSc, FRCPC, Department of Anesthesiology, Royal University Hospital, University of Saskatchewan, 103 Hospital Dr., Saskatoon, Saskatchewan, Canada S7N 0W8. Address e-mail to campbelld{at}sdh.sk.ca
Dilute concentrations of bupivacaine combined with fentanyl have recently been used to initiate labor epidural analgesia in an attempt to balance adequate analgesia and minimal maternal motor blockade. Similar concentrations of ropivacaine have not been evaluated. This prospective, randomized, double-blinded study was designed to compare the efficacy of 20 mL of either 0.08% bupivacaine plus 2 µg/mL fentanyl or 0.08% ropivacaine plus 2 µg/mL fentanyl to initiate ambulatory labor epidural analgesia. Forty nulliparous women in early ( 5 cm) established labor received either 20 mL of 0.08% bupivacaine plus 2 µg/mL fentanyl (BF) or 0.08% ropivacaine plus 2 µg/mL fentanyl (RF) to initiate epidural analgesia. One woman (BF) required supplemental analgesia, and two (one BF and one RF) had visual analog scale scores > 0 but < 20 at 20 min. The time (mean ± SD) to visual analog scale score = 0 was BF (n = 18): 12.0 ± 4.5 min and RF (n = 19): 12.4 ± 4.0 min (P > 0.05). Spontaneous micturition was observed in 65% (13 of 20) BF compared with 100% (20 of 20) RF (P < 0.01), and ambulation was demonstrated in 75% (15 of 20) BF compared with 100% (20 of 20) RF (P < 0.03). The incidence of forceps delivery was 35% (7 of 20) BF compared with 10% (2 of 20) RF (P < 0.04). The results of this study indicate that dilute ropivacaine combined with fentanyl effectively initiates epidural analgesia while concurrently preserving maternal ability to void and ambulate.
Implications: As compared with a similar dilute concentration of bupivacaine, 20 mL of dilute (0.08%) ropivacaine combined with fentanyl (2 µg/mL) effectively initiates epidural analgesia in nulliparous women in early, established labor while preserving their ability to micturate and ambulate. Of importance, it appears that a true ambulatory epidural analgesic for women in labor is now possible.
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]
|
 |
|

|
 |

|
 |
 
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]
|
 |
|

|
 |

|
 |
 
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]
|
 |
|

|
 |

|
 |
 
M. Senard, A. Kaba, M. J. Jacquemin, L. M. Maquoi, M.-P. N. Geortay, P. D. Honore, M. L. Lamy, and J. L. Joris
Epidural Levobupivacaine 0.1% or Ropivacaine 0.1% Combined with Morphine Provides Comparable Analgesia After Abdominal Surgery
Anesth. Analg.,
February 1, 2004;
98(2):
389 - 394.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Frenea, C. Chirossel, R. Rodriguez, J.-P. Baguet, C. Racinet, and J.-F. Payen
The Effects of Prolonged Ambulation on Labor with Epidural Analgesia
Anesth. Analg.,
January 1, 2004;
98(1):
224 - 229.
[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]
|
 |
|

|
 |

|
 |
 
N. R. Connelly, R. K. Parker, T. Pedersen, T. Manikantan, T. Lucas, S. Serban, M. El-Mansouri, S. DuBois, E. D. Santos, A. Rizvi, et al.
Diluent Volume for Epidural Fentanyl and Its Effect on Analgesia in Early Labor
Anesth. Analg.,
June 1, 2003;
96(6):
1799 - 1804.
[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]
|
 |
|

|
 |

|
 |
 
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]
|
 |
|

|
 |

|
 |
 
N. R. Connelly, R. K. Parker, T. Lucas, M. El-Mansouri, V. Komanduri, P. Nayak, S. Gutta, C. Gibson, and S. M. Dunn
The Influence of a Bupivacaine and Fentanyl Epidural Infusion After Epidural Fentanyl in Patients Allowed to Ambulate in Early Labor
Anesth. Analg.,
October 1, 2001;
93(4):
1001 - 1005.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. B. Whiteside and J. A. W. Wildsmith
Developments in local anaesthetic drugs
Br. J. Anaesth.,
July 1, 2001;
87(1):
27 - 35.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. O. Columb, L. S. Polley, and D. C. Campbell
Potencies and Probabilities: One-Sided P Values Suggest a One-Sided Story!
Anesth. Analg.,
January 1, 2001;
92(1):
278 - 279.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. Gogarten and H. Van Aken
A Century of Regional Analgesia in Obstetrics
Anesth. Analg.,
October 1, 2000;
91(4):
773 - 775.
[Full Text]
[PDF]
|
 |
|
|