STUDY COMPARING DIFFERENT CONCENTRATIONS OF ROPIVACAINE 0.125% VS 0.2%, WHEN GIVEN WITH FENTANYL 2 MCG/ML FOR EPIDURAL LABOUR ANALGESIA

Abstract

Introduction: Analgesic adequacy during labor along with the avoidance of adverse effects is
vital for obstetric conditions. Painful labor can have negative impacts on maternal and fetal
physiology. In neuraxial analgesia, the analgesics are injected or infused in close proximity to the spinal cord by using catheter, usually either intrathecally into the cerebrospinal fluid or
epidurally into the fatty tissues around the dura, to block nerves that transmits pain signals to the brain. Much lower pain scores with least adverse effects on maternal cardiovascular or
pulmonary functions and fetal physiology with higher maternal satisfaction are reported with the use of neuraxial analgesic techniques during labor and delivery.
Materials and Methods: A total of 100 parturients in active labor were randomly assigned to
two groups of 50 each, to receive an epidural injection of 10 ml ropivacaine 0.125% with fentanyl (2 mcg/ml) in group R1 and 10 ml of ropivacaine 0.2% with fentanyl (2 mcg/ml) in
group R2 as initial bolus dose. Same dose regimen was used as subsequent top-up dose on
patients demand for pain relief. The duration and quality of analgesia, motor block, top-up doses required, consumption of ropivacaine and fentanyl and foetomaternal out come in both groups were compared.
Results: Effective labor analgesia with no motor blockade was observed in both groups. The
mean age in group R1 was 22.7 ± 1.70 years which was lesser when compared to group R2 (23.5 ± 1.15 years). Height, weight and parity did not show much variation in both groups. Duration of analgesia after initial bolus dose was also significantly longer in group R2 (126.40 ± 10.41 min) than in group R1 (73.17± 27.50 min).
Conclusion: We find that both ropivacaine (0.2% and 0.125%) and fentanyl concentrations were efficacious in generating epidural labour analgesia. 0.2% concentration was found to be superior in terms of duration, breakthrough pain, requiring fewer top-ups, and opioid use. For labour analgesia, our study recommends 10 ml of 0.2% ropivacaine plus 2 mcg/ml fentanyl over 0.125% ropivacaine