Comparative Efficacy of 0.0625% Racemic Bupivacaine with Fentanyl versus 0.2% Ropivacaine with Fentanyl for Epidural Labour Analgesia: A Prospective, Randomised, Double-Blind Study

Abstract

Introduction: Epidural analgesia is a safe method of pain relief during labour. Local anaesthetic in combination with opioids is used to achieve good pain relief without compromising motor function or fetomaternal safety and well-being. The aim of this study was to compare the effectiveness of 0.0625% racemic bupivacaine and fentanyl, and 0.2% ropivacaine and fentanyl, for epidural labour analgesia. Materials and Methods: This prospective, randomised, double-blind study included 100 ASA physical status I – II term parturients with a cervical dilatation of more than 3 cm in active labour, who were divided into two groups of 50 parturients each. Groups B and R were infused with 10 mL of 0.0625% racemic bupivacaine and 2 µg/mL of fentanyl via a lumbar epidural catheter, respectively. Assessing pain scores, onset and duration of analgesia, sensory and motor block, maternal hemodynamics, fetal heart rate, drug consumption, mode of delivery, neonatal outcome, adverse effects and maternal satisfaction were carried out. Results: Baseline maternal parameters and demographic factors were similar between the groups. In both regimens adequate labour analgesia was provided without any clinically significant motor blockade. The characteristics of sensory block were comparable, as were maternal hemodynamics, fetal heart rate, mode of delivery and Apgar scores. Fewer boluses were needed in Group R, and the dosage of fentanyl was less in Group R than in Group B. The mean duration of analgesia was 246.26 minutes in Group R and 237.40 minutes in Group B. This correlated with reduced breakthrough pain and improved satisfaction of mothers. Conclusion: Both 0.0625% racemic bupivacaine and 0.2% ropivacaine, when combined with fentanyl, provide effective and safe epidural labour analgesia. Ropivacaine resulted in decreased requirement of supplemental analgesics and improved maternal satisfaction. Clinical Trial Registration Number: REF/2026/09/140236