Comparative Evaluation of Ropivacaine 0.2% with Fentanyl and Levobupivacaine 0.125 % with Fentanyl as Adjunct in Epidural Labour Analgesia: A Randomised Control Clinical Study

Abstract

Introduction: Labor is described as a series of actions that occur in the genital organs in order to evacuate the viable products of conception from the womb and into the outside world through the vaginal canal. Pain is an unpleasant and painful input that causes pathophysiological responses.
Aims: To compare the efficacy of labour epidural analgesia with Levobupivacaine 0.125% with Fentanyl 2mcg/ml and Ropivacaine 0.2% with Fentanyl 2mcg/ml. Materials and methods: Study was conducted in 60 parturients, of age group 18-35 years admitted to Gandhi Hospital for safe institutional delivery from 2016-2017. They were randomly divided into two groups of 30 each ,Group L: This group of patients received Levobupivacaine 0.125% and Fentanyl 2mcg/ml ,Group R: This group of patients received Ropivacaine 0.2% and Fentanyl 2mcg/ml and Intermittent bolus dose regimen was followed and 5ml of study drug solution given every hourly. Continuous monitoring of SBP, DBP, HR and SPo2 were done and study parameters were be recorded. Results: VAS scores between the two groups. Volume of local anaesthetic mixture recorded were 33.6+/- 4.33 ml in Levobupivacaine group compared to 32.8+/- 4.2ml in Ropivacaine group which translates to an approximate of 8.6ml/hour for Levobupivacaine group and 8.28ml/hour for Ropivacaine group. Time for first top-up was observed to be 57.1 +/- 3.98 minutes for Levobupivacaine group and 62.53 +/- 4.9 min for Ropivacaine group. Incidence of pruritus was 8/30 in Levobupivacaine group and 7/30 in Ropivacaine group. Post epidural placement, statistically significant differences were observed in VAS at 5min and 10 min with higher values recorded in Levobupivacaine group and Ropivacaine group.Conclusion : Both Levobupivacaine and Ropivacaine are safe in providing labour analgesia via epidural route and that Ropivacaine had a significantly faster onset and only mildly prolonged analgesia.