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| |  ESRA: Ropivacaine as Effective as Bupivacaine as Epidural Analgesic in Labor By Cameron Johnston Special to DG News WARSAW, POLAND -- September 21, 2001 -- Despite being a less potent drug (1), ropivacaine (Naropin, AstraZeneca) is as effective an epidural anaesthetic as is bupivacine (Carbostesin, AstraZeneca) when used in combination with sufentanil and epinephrine for multiparous mothers. Ropivacaine, in fact, may be less potent, but there were few, if any, significant differences in outcomes either for the mother or the neonates in a study of 100 women who received the two drugs. The two drugs were similar on almost all measurements, according to Dr. Sarah Haspeslagh, of the department of anaesthesia at the Katholieke Universiteit Hospital in Leuven, Belgium, who presented the results of her study yesterday (September 20) at the annual meeting of the European Society for Regional Anaesthesia and the European Society for Obstetric Anaesthesia, in Warsaw, Poland. The women in the study completed non-complicated pregnancies, all singlet births, and at the time of delivery received sufentanil 0.75 µg/mL and epinephrine 1.25 µg/mL. The women were also assigned to one of two groups: one received ropivacaine 0.175%, and the other received bupicavaine 0.125% in their epidural anaesthesia. Patients were further given the opportunity to use self-controlled epidural analgesia, which was set to a maximum of 10 mL, every 15 minutes if needed. Parameters that were measured for the study include quality of pain control, sensory and motor block, fetal and neonate well-being, including heart rate, labor outcome and side effects, and hemodynamics. There were no differences in demographics between the women or their neonates, nor were there differences in labor and delivery times. Length of labor ranged from 175 to 187 minutes in the bupivacaine and ropivacaine groups, respectively, while first stage labor ran from 152 to 161 minutes in the two groups, respectively. There were no statistically significant differences in maternal heart rate or blood pressure, or in motor block between the two groups. Nor were there inter-group differences in fetal heart rate, which showed changes in 18 of 50 cases in the bupivacaine group and 16 of 50 in the ropivacaine group. The only measurements where significant differences were seen were for hypertonia, which occurred in four patients in the ropivacaine group but in none of the patients in bupivacaine group, and in the use of self-controlled analgesic. Patients in the ropivacaine group used more self-administered analgesic, both in total and each hour. There was also less pruritis in the ropivacaine group (8/50) compared with the bupivacaine group (20/50), which was similar to the incidence that had been seen in other studies comparing the two drugs. Overall, Dr. Haspeslagh said, patient satisfaction and outcomes were similar between the two groups. These findings suggest that either drug could be used interchangeably, although since ropivacaine is less potent, this could mean women who are less susceptible to pain, or who do not respond to pain as strongly as some women might prefer to use the less potent drug. Other than that, Dr. Haspeslagh concluded, ropivacaine is safe and effective and can be used as an alternative to bupivacaine for in a labor analgesic where there is back-up with patient-controlled epidural anaesthesia. (1) Campogna et al, Br J Anaesth 1999, 82: 371.
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