Highlights
- •Comparison of bupivacaine and levobupivacaine.
- •Decreasing local anesthetic concentration reduces labor epidural analgesia efficacy.
- •Satisfaction with labor analgesia is not affected by local anesthetic concentration.
- •Local anesthetic concentration affects the incidence of motor block.
Abstract
Background
The study aim was to evaluate the efficacy and safety of different low concentrations
of two local anesthetics for labor analgesia using patient-controlled epidural analgesia.
Methods
A double-blind, randomized controlled trial recruiting healthy nulliparous women was
conducted from 2014 to 2017. Epidural analgesia was provided using local anesthetic
and fentanyl. Patients were allocated to six groups, according to the concentration
of bupivacaine or levobupivacaine (0.0625%, 0.1%, 0.125%). Analgesic efficacy, vital
parameters, and side effects were evaluated at different time points. Satisfaction
was evaluated using verbal and written scores. The primary outcome was the total dose
of local anesthetic used.
Results
Two-hundred-and-thirty-seven cases were analyzed. The total dose of local anesthetic
was significantly lower in the two lower concentration groups (P <0.0001). The rate of cesarean section was lower in 0.1% bupivacaine versus 0.1%
levobupivacaine (P=0.005), 0.125% levobupivacaine (P=0.049) and 0.125% bupivacaine (P=0.002) groups. Pain breakthrough, patient-controlled and rescue boluses were significantly
different between groups (P=0.03, P=0.003 and P <0.0001 respectively). The rate of motor block increased with higher concentrations
(P=0.033), but the incidence of other maternal and fetal side effects was not significantly
different. Satisfaction with labor analgesia did not differ across groups. Satisfaction
score 72 hours after delivery was significantly lower than that two hours after delivery
(P <0.0001).
Conclusions
Higher local anesthetic concentration resulted in higher total doses infused and greater
motor block. Labor analgesia was less effective when the lowest concentrations were
used, but patient satisfaction was unaffected.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of Obstetric AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Programmed intermittent epidural boluses for maintenance of labour analgesia: an impact study.Int J Obstet Anesth. 2016; 26: 32-38
- Effects of local anesthetic on the time between analgesic boluses and the duration of labor in patient-controlled epidural analgesia: prospective study of two ultra-low dose regiments of ropivacaine and sufentanil.Acta Med Port. 2015; 28: 70-76
- The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis.Can J Anaesth. 2013; 60: 840-854
- Effects of epidural labor analgesia with low concentrations of local anesthetics on obstetric outcomes: a systematic review and meta-analysis of randomized controlled trials.Anesth Analg. 2017; 124: 1571-1580
- Maternal ambulation during labor.Curr Opin Anaesthesiol. 2011; 24: 268-273
- Analgesia in obstetrics.Geburtshilfe Frauenheilkd. 2012; 72: 596-601
- Effects of epidural analgesia on uterine artery Doppler in labour.Br J Anaesth. 2011; 106: 221-224
- Patient-controlled epidural analgesia for labor.Anesth Analg. 2009; 108: 921-928
Available at: https://eprovide.mapi-trust.org/instruments/new-mother-quality-of-care-questionnaire-com Accessed [May 2014].
- Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor: a randomized clinical trial.Chin Med J. 2010; 123: 178-183
- A randomized controlled trial using patient-controlled epidural analgesia with 0.25% versus 0.0625% bupivacaine in nulliparous labor: effect on analgesia requirement and maternal satisfaction.Int J Obstet Anesth. 2010; 19: 171-178
- Continuous patient-controlled epidural infusion of levobupivacaine plus sufentanil in laboring primiparous women: effects of concentration.Anaesthesia. 2010; 65: 573-580
- Ropivacaine 0.15% plus sufentanil 0.5 µg/ml and ropivacaine 0.10% plus sufentanil 0.5 µg/ml are equivalent for patient-controlled epidural analgesia during labor.Anesth Analg. 2003; 96: 1173-1177
- Bupivacaine, levobupivacaine and ropivacaine: are they clinically different?.Best Prac Res Clin Anaestesiol. 2005; 19: 247-268
- Quality of labour neuraxial analgesia and maternal satisfaction at a tertiary care teaching hospital: a prospective observational study.Can J Anesth. 2013; 60: 787-795
- Mode of delivery and its influence on women's satisfaction with childbirth.Eur J Obstet Gynecol Reprod Biol. 2013; 170: 401-406
- Efficacy of ropivacaine, bupivacaine, and levobupivacaine for labor epidural analgesia.J Clin Anesth. 2007; 19: 214-217
- Ambulation in labour and delivery mode: a randomised controlled trial of high-dose vs mobile epidural analgesia.Anaesthesia. 2009; 64: 266-272
- Update on local anesthetics: focus on levobupivacaine.Ther Clin Risk Manag. 2008; 4: 381-392
- Motor blockade is reduced with ropivacaine 0.125% for parturient-controlled epidural analgesia during labour.Can J Anesth. 1999; 46: 1019-1023
- Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review.Arch Gynecol Obstet. 2014; 290: 21-34
- Method of analgesia for labor in relation to newborn condition, cord blood cortisol and interleukin-6 levels.Ginek Pol. 2011; 82: 767-774
- Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis.BMJ. 2010; 340https://doi.org/10.1136/bmc.c1471
- Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term.Obstet Gynecol. 2014; 24: 756-761
- Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia.Clin Risk Manag. 2016; 12: 1107-1112
- Epidural analgesia for labor. Continuous infusion versus programmed intermittent bolus.Anesthesiol Clin. 2017; 35: 1-14
Article info
Publication history
Published online: May 17, 2018
Accepted:
May 9,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
