A randomized comparison of levobupivacaine, bupivacaine and ropivacaine with fentanyl, for labor analgesia

Background

To compare the analgesic efficacy of epidural infusions of levobupivacaine, bupivacaine and ropivacaine in labor.

Methods

102 nulliparous parturients in early labor were enrolled in this randomized, double-blind clinical trial. They were randomly assigned to receive one of three continuous epidural infusion regimens: levobupivacaine 0.125%, bupivacaine 0.125% or ropivacaine 0.2%, all with fentanyl 1μg/mL at 8mL/h. Supplementary analgesia was provided with an 8-mL epidural bolus of the study solution if visual analogue scale (VAS) score for pain was ⩾40 (0-100mm). Pain and motor and sensory block were measured at 0, 15 and 30min, 1, 2, 3 and 4h and full cervical dilatation.

Results

Analgesia was satisfactory in all three groups, with VAS score <40mm at all measurements. VAS scores were greater in those receiving levobupivacaine (P<0.005). Motor block was greater with bupivacaine than levobupivacaine (P<0.01). There were no differences in motor block between levobupivacaine and ropivacaine. There were no other differences between groups.

Conclusion

All three regimens were effective during first stage of labor although pain scores were higher in those receiving levobupivacaine. Motor block was greater with bupivacaine than with levobupivacaine.

Keywords: Analgesia: obstetric, epidural, Anesthetics, local: levobupivacaine, bupivacaine, ropivacaine, Opioids: fentanyl