Comparative Study of Ropivacaine-Fentanyl Versus Bupivacaine-Fentanyl for Epidural Labour Analgesia -Prospective Randomised Control Study

Abstract

Background: Ropivacaine has emerged as a promising alternative to Bupivacaine as a local anesthetic for epidural labor analgesia. Ropivacaine had shown lesser cardiotoxicity and less intense motor block compared to bupivacaine which makes it safer to use in obstetric populations during labor. The purpose was to compare the efficacy, safety, and maternal satisfaction associated with the use of Ropivacaine with fentanyl and Bupivacaine with fentanyl as epidural block for inducing labor analgesia. Methodology: A Randomized controlled trial following single blinding method was conducted with 120 patients who were in active labor with vertex presentation in the age group of 18 - 35 years. They were randomly divided into two groups of equal numbers and one group of patients received 10 ml of 0.125 % ropivacaine along with 2 mcg/ml fentanyl and the other group of patients received 10 ml of 0.125% bupivacaine analgesia along with 2 mcg/ml fentanyl. Sensory and motor block assessment was done using standard scales. Hemodynamic parameters, adverse events and their obstetric outcomes were recorded and compared. Results: Onset of analgesia and the VAS scores at 15th and 30th mins were almost similar in both the groups p (>.05). The duration of analgesia was significantly higher among the ropivacaine group in comparison with bupivacaine (126.4 mins vs 103.2 mins). Motor block assessment was found to be slightly favourable for ropivacaine compared to bupivacaine but was not statistically significant (p=0.077). Hemodynamic parameters were found to be safe and similar in both the groups. Similarly, is the obstetric outcome and there were no adverse events reported among the two groups. Conclusion: Epidural labor analgesia using similar concentrations of ropivacaine or bupivacaine in combination with fentanyl produced comparable analgesic outcomes. Ropivacaine showed a slight advantage in terms of longer duration of analgesia while preserving motor function.