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A Prospective Comparative Study of Combined Spinal Epidural with (0.1%) Ropivacaine versus (0.1%) Levobupivacaine with Fentanyl for Labour Analgesia

S.V. Ravikanth, Associate Professor, Department of Anaesthesia, Konaseema Institute of Medical Science, Amalapuram, Andhra Pradesh 533201, India. , V.S.S.N. Murthy1 , S.V. Ravi Kanth2 , Anand Acharya3

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Indian Journal of Anesthesia and Analgesia 5(7):p 1204-1209, July 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5718.18

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Abstract

Background: Various studies have been conducted regarding efficacy of Bupivacaine, Levobupivacaine and Ropivacaine; all these drugs provide adequate analgesia without significant effect on duration of Labour and neonatal outcome. But Levobupivacaine and ropivacaine has been encouraged in low dose that is 0.1%, because of more safety and less motor block. 

Material and Method: Parturients with singleton pregnancy, cephalic presentation and active labour were selected for this study as per exclusion and inclusion criteria, they were randomized by computer generated randomization table into two groups. Each group consists of 30 patients – group I and group II. Group I parturients received 3mg of isobaric Levobupivacaine with 25ug fentanyl intrathecally followed by epidural top ups of 14ml 0.125% isobaric Levobupivacaine and 30ug fentanyl making total volume of 15ml. Group II parturients in this group received 4mg isobaric ropivacaine with 25ug fentanyl intrathecally followed by epidural top-ups of 14ml 0.2% isobaric ropivacaine and 30ug fentanyl making total volume of 15ml.

Result: Similar both group were statistically comparable to each other with respect to height, weight, ASA scare and cervical dilatation. Regarding block characteristics, the maximal dermatomal level of sensory block achieved in group I was T5 and in group II it was T6 with P value 0.04. Seven parturient in group I and five parturient in group II has developed grade 1 motor blockade. The mean time of onset of analgesia was 4.52 min in group I and 5.95 min in group II with P value 0.00001. The duration of analgesia was longer in group I then group II (107.06±13.06 versus 91.43±9.38) with P value 0.00001. The number of epidural top up requirement was less in group I then group II (1.287±0.192 versus 1.71±0.267) with P value 0.00053.

Discussion and Conclusion: Onset of analgesia was early in group I then group II.The duration of analgesia was longer in group I then group II, The number of epidural top-up requirement was more in group II. To conclude both drugs found to be effective in respect to onset and duration of analgesia but Levobupivacaine was better than ropivacaine.

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5718.18

Keywords

Ropivacaine; Levobupivacaine; Labour Analgesia.

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