A clinical study of comparison of effect with 0.15% ropivacaine and fentanyl 2mcg/ml versus 0.125% bupivacaine and fentanyl 2mcg/ml epidurally for labour analgesia

Pravin Kumar, Vijay Kanna, Kirubahar ., Azagappan .


Background: Adequate pain control is vital during labor as it can have negative impacts on maternal and fetal physiology. Epidural Bupivacaine with opioid has been in use for many years. Ropivacaine is almost similar to bupivacaine in terms of onset, duration, and quality of sensory blockade, but it is less toxic and produces less motor blockade.

Methods: Authors did a prospective randomized controlled study on 50 prim gravidas of ASA I category with singleton pregnancy in full-term labor, undergoing normal vaginal delivery, admitted to the antenatal ward requesting labor analgesia. They were randomly divided into two groups of 25 each receiving 8 ml Epidural bolus of either 0.125% Bupivacaine with 2ug/ml Fentanyl or 0.15% Ropivacaine with 2ug/ml Fentanyl by the epidural catheter.

Results: Analgesia in Ropivacaine group lasted 7.84 minutes longer than Bupivacaine group (p<0.001). Only 28% in the Ropivacaine group needed 3 analgesia top-ups or more compared to 76% in Bupivacaine group. No one out of 25 subjects in Ropivacaine group developed motor block, whereas 21 subjects (84%) in Bupivacaine group developed partial motor (grade 2) block. There was no significant difference in maternal or neonatal outcome between the groups.

Conclusions: Subjects in Ropivacaine group on comparison with Bupivacaine group experienced excellent labor analgesia, with greater duration of action, and reduced fentanyl, a local anesthetic requirement with similar VAS scores, maternal and neonatal outcomes besides the major advantage of reduced incidence of motor block.



Bupivacaine, Epidural analgesia, Fentanyl, Labour analgesia, Ropivacaine

Full Text:



Jung H, Kwak KH. Neuraxial analgesia: a review of its effects on the outcome and duration of labor. Korean J Anesthesiol. 2013;65(5):379-84.

Hitzeman N, Chin S. Epidural analgesia for labor pain. Am Fam Physician. 2012;86(3):241-2.

Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011(12):Cd000331.

Pan PH, Eisenach JC. The pain of childbirth and its effect on the mother and the fetus. Obstetric anesthesia principles and practice 4th Ed Philadelphia: Elsevier Mosby; 2009:387-404.

Asik I, Goktug A, Gulay I, Alkis N, Uysalel A. Comparison of bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl for epidural analgesia during labour. Eur J Anaesthesiol. 2002;19(4):263-70.

Dresner M, Freeman J, Calow C, Quinn A, Bamber J. Ropivacaine 0.2% versus bupivacaine 0.1% with fentanyl: a double blind comparison for analgesia during labour. Br J Anaesth. 2000;85(6):826-9.

Fernandez-Guisasola J, Serrano ML, Cobo B, Munoz L, Plaza A, Trigo C, et al. A comparison of 0.0625% bupivacaine with fentanyl and 0.1% ropivacaine with fentanyl for continuous epidural labor analgesia. Anesth Analg. 2001;92(5):1261-5.

Burnstein R, Buckland R, Pickett JA. A survey of epidural analgesia for labour in the United Kingdom. Anaesthesia. 1999;54(7):634-40.

Hansen TG. Ropivacaine: a pharmacological review. Expert Rev Neurother. 2004;4(5):781-91.

Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian Journal of Anaesthesia. 2011;55(2):104-10.

Lev-Wiesel R, Chen R, Daphna-Tekoah S, Hod M. Past traumatic events: are they a risk factor for high-risk pregnancy, delivery complications, and postpartum posttraumatic symptoms? J Womens Health (Larchmt). 2009;18(1):119-25.

Sharma SK, McIntire DD, Wiley J, Leveno KJ. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology. 2004;100(1):142-8; discussion 6A.

Halpern SH, Carvalho B. Patient-controlled epidural analgesia for labor. Anesth Analg. 2009;108(3):921-8.

Brown ST, Campbell D, Kurtz A. Characteristics of labor pain at two stages of cervical dilation. Pain. 1989;38(3):289-95.

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(3):632-7.

Halpern SH, Walsh V. Epidural ropivacaine versus bupivacaine for labor: a meta-analysis. Anesth Analg. 2003;96(5):1473-9.

Neha A, Saroj S, Uma S, Richa S, Anu P, Komal J, et al. A comparison of epidural analgesia with 0.1% ropivacaine or 0.1% bupivacaine both with fentanyl during labor: effect on analgesia, ambulation and progress of labor. Anesthesia Update. 2012;15:38-42.

Paddalwar S, Nagrale M, Chandak A, Shrivastava D, Papalkar J. A randomized, double-blind, controlled study comparing Bupivacaine 0.125% and Ropivacaine 0.125%, both with Fentanyl 2 μg/ml, for labor epidural analgesia. Indian J Pain. 2013;27(3):147.

Guo S, Li B, Gao C, Tian Y. Epidural Analgesia With Bupivacaine and Fentanyl Versus Ropivacaine and Fentanyl for Pain Relief in Labor: A Meta-Analysis. Medicine (Baltimore). 2015;94(23):e880.

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(3):371-3.

Beilin Y, Halpern S. Focused review: ropivacaine versus bupivacaine for epidural labor analgesia. Anesth Analg. 2010;111(2):482-7.