Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-23T07:08:30.771Z Has data issue: false hasContentIssue false
  • English
  • Français

A multicentre trial comparing different concentrations of ropivacaine plus sufentanil with bupivacaine plus sufentanil for patient-controlled epidural analgesia in labour

Published online by Cambridge University Press:  23 December 2004

W. Gogarten ,
M. Van de Velde ,
F. Soetens ,
H. Van Aken ,
G. Brodner ,
H.-F. Gramke ,
M. Soetens  and
M. A. E. Marcus
W. Gogarten
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Germany
M. Van de Velde
Affiliation:
Katholieke Universiteit Leuven, Department of Anesthesiology, Belgium
F. Soetens
Affiliation:
Sint Elisabeth Hospital, Department of Anesthesiology, Turnhout, Belgium
H. Van Aken
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Germany
G. Brodner
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Germany
H.-F. Gramke
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Germany
M. Soetens
Affiliation:
Sint Elisabeth Hospital, Department of Anesthesiology, Turnhout, Belgium
M. A. E. Marcus
Affiliation:
Academisch Ziekenhuis Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
Get access

Extract

Summary

Background and objective: To determine the optimal concentration of ropivacaine for bolus-only patient-controlled epidural labour analgesia, three different doses of ropivacaine were evaluated in comparison with bupivacaine in a double-blinded multicentre study.

Methods: Four hundred-and-fifty labouring parturients at term in three different academic institutions were randomized to four groups receiving bupivacaine 0.125% with sufentanil 0.75 μg mL−1, ropivacaine 0.125% or 0.175% with sufentanil 0.75 μg mL−1, or ropivacaine 0.2%. After an initial bolus of 10 mL of the study solution, and once visual analogue scores (VAS) were below 30 mm, patient-controlled epidural analgesia was initiated with a bolus of 4 mL, a lockout interval of 15 min and without a background infusion. Variables studied were the quality of analgesia, incidence of side-effects, the degree of motor blockade, and the mode of delivery.

Results: Bupivacaine 0.125% and ropivacaine 0.125% with sufentanil proved equally effective in providing labour analgesia without a difference in local anaesthetic consumption (48.6 ± 23 mg bupivacaine vs. 52.1 ± 38 mg ropivacaine), motor blockade or mode of delivery. Ropivacaine 0.175% plus sufentanil enhanced the quality of analgesia of the initial loading dose, whereas ropivacaine 0.2% without sufentanil increased the consumption of local anaesthetics (80.2 ± 34 mg; P < 0.05) and the degree of motor blockade.

Conclusion: Despite recent studies indicating that bupivacaine and ropivacaine may not be equipotent, both local anaesthetics provided equi-effective analgesia at equal doses without a difference in side-effects.

Keywords

ANAESTHETICS, LOCALropivacaine, bupivacaineANALGESIA, EPIDURALANALGESIA, PATIENT-CONTROLLEDNARCOTICS, sufentanilOBSTETRICSPREGNANCY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 1 , January 2004 , pp. 38 - 45
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Scott DB, Lee A, Fagan D, Bowler GMR, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–569.Google Scholar
Zaric D, Nydahl PA, Philipson L, Samuelsson L, Heierson A, Axelsson K. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2%, and 0.3%) and 0.25% bupivacaine on sensory and motor block in volunteers: a double-blind study. Reg Anesth 1996; 21: 14–25.Google Scholar
Benhamou D, Hamza J, Eledjam JJ, et al. Continuous extradural infusion of ropivacaine 2 mg mL−1 for pain relief during labour. Br J Anaesth 1997; 78: 748–750.Google Scholar
Gautier P, De Kock M, Van Steenberge A, Miclot D, Fanard L, Hody JL. A double-blind comparison of 0.125% ropivacaine with sufentanil and 0.125% bupivacaine with sufentanil for epidural labor analgesia. Anesthesiology 1999; 90: 772–778.Google Scholar
Owen MD, D'Angelo R, Gerancher JC, et al. 0.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patient-controlled epidural infusion. Anesth Analg 1998; 86: 527–531.Google Scholar
Gambling DR, McMorland GH, Yu P, Laszlo C. Comparison of patient-controlled epidural analgesia and conventional intermittent ‘top-up’ injections during labor. Anesth Analg 1990; 70: 256–261.Google Scholar
Purdie J, Reid J, Thorburn J, Asbury AJ. Continuous extradural analgesia: comparison of midwife top-ups, continuous infusions and patient controlled administration. Br J Anaesth 1992; 68: 580–584.Google Scholar
Paech MJ. Patient-controlled epidural analgesia in labour – is a continuous infusion of benefit? Anaesth Intens Care 1992; 20: 15–20.Google Scholar
Bernard JM, Le Roux D, Vizquel L, et al. Patient-controlled epidural analgesia during labor: the effects of the increase in bolus and lockout interval. Anesth Analg 2000; 90: 328–332.Google Scholar
Vertommen JD, Lemmens E, Van Aken H. Comparison of the addition of three different doses of sufentanil to 0.125% bupivacaine given epidurally during labour. Anaesthesia 1994; 49: 678–681.Google Scholar
Loftus JR, Hill H, Cohen SE. Placental transfer and neonatal effects of epidural sufentanil and fentanyl administered with bupivacaine during labor. Anesthesiology 1995; 83: 300–308.Google Scholar
Vertommen JD, Vandermeulen E, Van Aken H, et al. The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labor and on the incidence of instrumental deliveries. Anesthesiology 1991; 74: 809–814.Google Scholar
Van Zundert A, Vaes L, Van der Aa P, Van der Donck A, Meeuwis H. Motor blockade during epidural anesthesia. Anesth Analg 1986; 65: 333–336.Google Scholar
Capogna G, Celleno D, Fusco P, Lyons G, Columb M. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Br J Anaesth 1999; 82: 371–373.Google Scholar
Polley LS, Columb MO, Naugton NN, Wagner DS, van de Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology 1999; 90: 944–950.Google Scholar
Fernández-Guisasola J, Serrano ML, Cobo B, et al. A comparison of 0.0625% bupivacaine with fentanyl and ropivacaine with fentanyl for continuous epidural labor analgesia. Anesth Analg 2001; 92: 1261–1265.Google Scholar
Owen M, Thomas JA, Smith T, Harris LC, D'Angelo R. Ropivacaine 0.075% and bupivacaine 0.075% with fentanyl 2 mg/mL are equivalent for labor epidural analgesia. Anesth Analg 2002; 94: 179–183.Google Scholar
Duggan J, Bowler GMR, McClure JH, Wildsmith JAW. Extradural block with bupivacaine: influence of dose, volume, concentration and patient characteristics. Br J Anaesth 1988; 61: 324–331.Google Scholar
Nielsen TH, Kristoffersen E, Olsen KH, Larsen HV, Husegaard HC, Wernberg M. Plain bupivacaine: 0.5% or 0.25% for spinal analgesia? Br J Anaesth 1989; 62: 164–167.Google Scholar
Liu SS, Ware PD, Rajendran S. Effects of concentration and volume of 2-chloroprocaine on epidural anesthesia in volunteers. Anesthesiology 1997; 86: 1288–1293.Google Scholar
Palm S, Gertzen W, Ledowski T, Gleim M, Wulf H. Minimum local analgesic dose of plain ropivacaine vs. ropivacaine combined with sufentanil during epidural analgesia for labour. Anaesthesia 2001; 56: 526–529.Google Scholar
Polley LS, Columb M, Wagner DS, Naughton NN. Dose-dependent reduction of the minimum local analgesic concentration of bupivacaine by sufentanil for epidural analgesia in labor. Anesthesiology 1998; 89: 626–632.Google Scholar
Vertommen JD, Lemmens E, Van Aken H. Comparison of the addition of three different doses of sufentanil to 0.125% bupivacaine given epidurally during labour. Anaesthesia 1994; 49: 678–681.Google Scholar
Finegold H, Mandell G, Ramanathan S. Comparison of ropivacaine 0.1%–fentanyl and bupivacaine 0.125%–fentanyl infusions for epidural labour analgesia. Can J Anesth 2000; 47: 740–745.Google Scholar
Fischer C, Blanié P, Jaouën E, Vayssière C, Kaloul I, Coltat JC. Ropivacaine, 0.1%, plus sufentantil, 0.5 mg/mL, versus bupivacaine, 0.1%, plus sufentanil, 0.5 mg/mL, using patient-controlled epidural analgesia for labor. A double-blind comparison. Anesthesiology 2000; 92: 1588–1593.Google Scholar
Meister GC, D'Angelo R, Owen M, Nelson KE, Gaver R. A comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labor. Anesth Analg 2000; 90: 632–637.Google Scholar
D'Angelo R, James RL, Stat SM. Is ropivacaine less potent than bupivacaine? Anesthesiology 1999; 90: 941–943.Google Scholar
Campbell DC. Potencies and probabilities: One-sided P values suggest a one-sided story! Response. Anesth Analg 2001; 92: 278–279.Google Scholar
Datta S, Camann W, Bader A, VanderBurgh L. Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine versus bupivacaine for cesarean section. Anesthesiology 1995; 82: 1346–1352.Google Scholar