Determination of ideal Ropivacaine level for optimal pain management during labor

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Created On: 19/09/2024

To investigate the ideal concentration of Ropivacaine for programmed intermittent epidural boluses (PIEBs) to balance pain relief and motor function.

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Key take away

Both 0.1% and 0.2% Ropivacaine concentrations offer effective pain relief during labor without motor blockade, but 0.2% provides better pain control, though with some trade-offs.

Background

To investigate the ideal concentration of Ropivacaine for programmed intermittent epidural boluses (PIEBs) to balance pain relief and motor function.

Method

This randomized controlled trial recruited 104 American Society of Anesthesiologists [ASA] I parturients, aged 18 to 45, scheduled for vaginal labor and compared two Ropivacaine concentrations (0.1% and 0.2% with Fentanyl 2 μg/ml). Key outcomes included motor blockade (measured by the modified Bromage scale), pain relief (measured by the visual analog scale [VAS]), and various maternal and newborn parameters.

Result

All the participants exhibited Bromage scores of 6, and anesthetic consumption was comparable in both groups. The 0.2% group experienced better pain relief and satisfaction as opposed to the 0.1% group, but had lower diastolic blood pressure, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores, and a less satisfactory extrusion stage as observed by the obstetrician.

Conclusion

Both 0.1% and 0.2% Ropivacaine provide effective pain management without motor blockade during labor. The 0.2% concentration offers superior pain relief but comes with minor drawbacks in blood pressure and newborn scores.