Chethanananda T N, Shashank M R, Madhu N, Achyutha J, Siva Kumar Karna Venkata
Department of Anaesthesiology, Sri Adichunchanagiri Hospital and Research Centre, Mandya, Karnataka, India.
Anesth Essays Res. 2017 Jul-Sep;11(3):583-588. doi: 10.4103/aer.AER_63_17.
This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia.
The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing.
Sixty parturients requesting for labor analgesia were divided into two groups. Group B ( = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 μg/ml of 10 ml and Group R ( = 30) received ropivacaine (0.1%) and fentanyl 2 μg/ml. In both groups, the drug was given in 5 ml fractionated doses at 5 min interval. Parturients not experiencing analgesia within 15 min of initial bolus were supplemented with additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed top ups at the end of 90 min with the dosage equal to the initial dose of the drug. Duration of labor analgesia, motor block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was assessed.
Data were analyzed with odds variance, unpaired -test, and Chi-square tests. < 0.05 was considered statistically significant.
In our study, results indicate that both drugs were equally effective clinically. Maternal demographic characteristics were comparable. There were no statistically significant differences in visual analog pain score, highest sensory block, maternal satisfaction, mode of delivery, total dose of LAs during labor and motor block at delivery between the groups.
In our study, both the drugs produced equivalent analgesia for labor at low concentration when used with highly lipid soluble opioid such as fentanyl.
本研究旨在比较局部麻醉药布比卡因和罗哌卡因与高脂溶性阿片类药物芬太尼的最低有效浓度，以提供最佳的分娩硬膜外镇痛。
本研究的目的是评估消旋布比卡因0.0625%和罗哌卡因0.1%与2μg/ml芬太尼混合用于自然分娩且胎儿心率监测正常的产妇硬膜外分娩镇痛的效果。
60名要求分娩镇痛的产妇被分为两组。B组（n = 30）接受消旋布比卡因（0.0625%）和2μg/ml芬太尼10ml，R组（n = 30）接受罗哌卡因（0.1%）和2μg/ml芬太尼。两组均以5ml分次剂量给药，间隔5分钟。初始推注后15分钟内未出现镇痛的产妇补充5ml相同浓度的溶液。硬膜外镇痛在90分钟结束时通过定时追加维持，追加剂量等于初始给药剂量。评估分娩镇痛持续时间、运动阻滞、视觉模拟评分、产妇血流动力学参数、分娩方式和产妇满意度。
数据采用比值方差、非配对 t 检验和卡方检验进行分析。P < 0.05被认为具有统计学意义。
在我们的研究中，结果表明两种药物在临床上同样有效。产妇人口统计学特征具有可比性。两组之间在视觉模拟疼痛评分、最高感觉阻滞、产妇满意度、分娩方式、分娩期间局部麻醉药总剂量和分娩时运动阻滞方面无统计学显著差异。
在我们的研究中，当与高脂溶性阿片类药物如芬太尼联合使用时，两种药物在低浓度下对分娩产生等效镇痛效果。
