A COMPARISON OF COMBINED SPINAL EPIDURAL ANALGESIA WITH 0.1% ROPIVACAINE WITH FENTANYL VERSUS 0.1% BUPIVACAINE WITH FENTANYL DURING LABOUR
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Keywords
Labour analgesia, Combined spinal-epidural, Ropivacaine, Bupivacaine, Fentanyl, Maternal satisfaction etc.
Abstract
Background: Labour pain is among the most severe forms of pain and requires effective management for maternal well-being and optimal delivery outcomes. Combined spinal-epidural (CSE) analgesia is a widely accepted technique that provides rapid, effective, and sustained pain relief during labour. This study compares the efficacy and safety of 0.1% ropivacaine with fentanyl versus 0.1% bupivacaine with fentanyl in CSE analgesia.
Methods: This prospective, randomized, double-blind controlled study included 64 healthy term parturients in active labour, divided equally into two groups. Group R received intrathecal 2.5 mg ropivacaine with 25 µg fentanyl followed by 0.1% ropivacaine with fentanyl epidurally. Group B received the same regimen with bupivacaine. Pain relief was assessed using visual analogue scale (VAS) scores. Other parameters observed included onset and duration of analgesia, motor blockade (Bromage scale), need for rescue top-ups, maternal satisfaction, obstetrician satisfaction, neonatal Apgar scores, and mode of delivery.
Results: Demographic profiles and baseline characteristics were similar across groups. The onset and duration of spinal analgesia did not differ significantly. Pain relief was effective in both groups, with mean VAS scores remaining low and statistically comparable. Group R showed slightly fewer motor block incidences and lower need for top-ups, though not statistically significant. Neonatal outcomes, including Apgar scores and birth weights, were similar. Patient satisfaction was rated as excellent or good by over 96% in both groups.
Conclusion: Both 0.1% ropivacaine-fentanyl and bupivacaine-fentanyl combinations provided effective and safe labour analgesia with high maternal and clinician satisfaction. Ropivacaine demonstrated a tendency for less motor block and may be preferred in scenarios where ambulation is desirable, though both agents remain clinically equivalent for use in CSE.
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Dr Komal Joshi
Assistant Professor, Department of Anesthesia Government Medical College, Azamgarh
Dr Surekha Saxena
Professor, Department of Anesthesia and Critical Care, SN Medical College, Agra
Dr Uma Srivastava
Professor, Department of Anesthesia and Critical Care, SN Medical College Agra
Dr Saroj Singh
Professor, Department of Obstetrics and Gynecology, SN MEDICAL College Agra