Evaluation of analgesic efficacy of the combination of fentanyl with low dose bupivacaine vs ropivacaine using patient controlled epidural analgesia for control of labour pain- an indian perspective!

Introduction: We undertook this study to compare the analgesic efficacy of 0.1% bupivacaine and 0.1% ropivacaine with fentanyl using patient controlled epidural analgesia. Materials & Methods: 60 parturients of ≥ 36 weeks of gestation with cephalic presentation in spontaneous labour with cervical dilatation ≤ 5 cms and baseline pain score of ≥ 30 on VAS, were enrolled in the study. Group I received 10 ml bolus of 0.1% bupivacaine with fentanyl 2µg/ml while Group II received 10 ml bolus of 0.1% ropivacaine with fentanyl 2µg/ml followed by patient controlled epidural analgesia (PCEA) using PCA pump. The primary outcome measured was analgesic efficacy using visual analogue scale. Results: VAS scores during first and second hour were found to be significantly lower in Group 1 as compared to Group 2 (Figure 1) with a significant difference from their respective baselines. Group II showed a statistically higher total drug consumption and number of boluses used (62.33 ± 26.6 vs 48.47 ± 16.7 and1.40 ± 0.8 vs 2.00 ± 0.8 respectively) as compared to group I (Table 2) (Figure 3). The motor block showed a statistically significant difference at 4th, 5th and 6th hours between the two groups. (Figure 4) Conclusion: The present study demonstrated that 0.1% ropivacaine or 0.1% bupivacaine with fentanyl 2 μg/ml used during labour analgesia by PCEA were equally effective for controlling the labour pain with more total drug consumption and less motor blockade associated with 0.1% ropivacaine as compared to 0.1% bupivacaine.