A Comparison of Continuous Infusion and Intermittent Bolus Administration of 0.1% Ropivacaine with Fentanyl for Combined Spinal Epidural Labor Analgesia: A Randomized Prospective Study.

Abstract

Background: To reduce maternal and perinatal morbidity arising due to pain-induced maternal sympathetic activation, maternal pain relief is essential, it not only benefits the parturient, but her neonate also. The availability of newer local anesthetics like ropivacaine and levo-bupivacaine has made Central neuraxial labor analgesia as the gold standard technique for pain control in obstetrics that is currently available, leading to higher maternal safety and satisfaction with better cardiovascular and pulmonary physiology. This study aims to investigate whether there are any differences exist between CEI and IEB analgesia for the parturients undergoing spontaneous delivery and the safety of these techniques in parturients and neonates.

Materials and method: This Prospective, randomized comparative study was conducted in 60 ASA physical status I or II women with term pregnancy, single, vertex presentation in active labor (cervical dilatation 3-4 cm) requesting labor analgesia.

Result: To achieve similar lower VAS, the mean total dose of ropivacaine was 19.33 ± 0.88 mg in Group I(IEB) and 24.66 ± 1.3 mg in Group B(CEI), the difference being statistically significant (P = 0.04). Parturient and anesthesiologists graded, acceptance rate as either excellent or “good” in all groups. Neonatal outcome was favorable in both the groups (APGAR scores >7 at 1 and 5 min) with no side-effect.

Conclusion: The study results support that intra-thecal 5mg ropivacaine with fentanyl and 0.1% ropivacaine of intermittent bolus through epidural is a ideal choice for labor analgesia. Intermittent bolus administration provides a more efficacious drug delivery route when compared to continuous infusion by decreasing the total amount of local anesthetic significantly without affecting patient safety or maternal satisfaction.