Comparison of three different concentrations of epidural ropivacaine (0.05%, 0.1% & 0.2%) for labor analgesia: A prospective randomized and double blind study Khandelwal Hariom1, Singh Kunal2,*, Agarwal Shikha3, Singh Ashutosh4, Bhattacharya Prithwis5 1Assistant Professor, Dept. of Anaesthesialogy, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand 2Assistant Professor, Dept. of Anaesthesialogy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 3Senior Resident, Dept. of Gynaecology and Obstetrics, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand 4Assistant Professor, Dept. of Anaesthesialogy, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand 5Professor and HOD, Dept. of Anaesthesialogy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India *Corresponding Author Email: drkunalsingh@outlook.com
Online published on 3 January, 2019. Abstract Introduction Epidural infusion of 0.2% ropivacaine is recommended by the manufacturer for labor analgesia, but lower concentrations may be effective. The present work is a clinical comparative study of different doses of ropivacaine i.e. 0.05%, 0.1% and 0.2%, each with 2 mcg/mL of fentanyl to find out minimum effective concentration of ropivacaine that can be used safely in epidural labor analgesia. Materials and Methods The study was conducted on sixty (60) parturient of ASA grade I and grade II physical status, in labor, with single fetus, vertex position, between 37–42 weeks gestation with regular contractions (true labor pain) with 4–6 cm cervix dilatation and who had requested labor analgesia. Parturients were then allocated randomly to one of three groups with 20 parturients in each group. Group 1 received 0.05% ropivacaine with 2 mcg/mL fentanyl, Group 2 received 0.1% ropivacaine with 2 mcg/mL fentanyl and Group 3 received 0.2% ropivacaine with 2 mcg/mL fentanyl. After completion of the study, the nonparametric data of the study was analyzed with Kruskal Wallis test and parametric data of the study was analyzed with ANOVA test and p value of < 0.05 was taken as statistically significant. Results Patient demographics and labor characteristics were comparable in all the groups. Ropivacaine 0.05% with 2 mcg/mL of fentanyl produced adequate analgesia for labor and delivery in only 50% of parturient while ropivacaine 0.1% & ropivacaine 0.2% with 2 mcg/mL of fentanyl produced adequate analgesia in 90% of parturient in group II and group III. Reduction in local anesthetic was not associated with any change in incidence of motor block or instrumental deliveries. Conclusion We concluded that the minimum concentration which can be used safely for labor analgesia with no adverse effect is 0.1% of ropivacaine with 2 mcg/mL fentanyl. Top Keywords Epidural, Labor analgesia, Ropivacaine, Fentanyl. Top |