Equipotent dose of levobupivacaine reduce the incidence of instrumental vaginal delivery when compared to ropivacaine during epidural labour analgesia

Abstract

Background: Instrumental vaginal delivery is a major concern during epidural labour analgesia. In previous studies levobupivacaine 0.1% was associated with increase in instrumental vaginal delivery when compared to 0.1% ropivacaine. Reducing the concentration of levobupivacaine may decrease the incidence of instrumental delivery. Hence, we compared 0.08% levobupivacaine and 0.1% ropivacaine with fentanyl as adjuvant for epidural labour analgesia in terms of mode of delivery. Methods: This prospective randomised controlled trial was conducted on 70 nulliparous parturients with singleton uncomplicated pregnancy. They were randomized into two groups to receive 0.08% levobupivacaine or 0.1% ropivacaine with 2μg/ml fentanyl as intermittent epidural boluses. The epidural analgesia was initiated with 12ml of study drug solution in active stage of labour and was maintained by repeated demand boluses whenever the Visual Analogue Scale (VAS) score was > 3. Onset, duration and quality of analgesia, degree of motor blockade was analysed. Primary outcome measure was the mode of delivery. Onset and duration of analgesia and Apgar score of baby were the secondary outcomes. Results: Instrumental vaginal delivery was 6.45% in levobupivacaine(L) and 4.54%in ropivacaine(R) group. However,11.4% and 37.1% parturients underwent caesarean section in group L and group R respectively (p=0.012**). Mean onset of analgesia and duration of analgesia was comparable. More than 80% of parturients had excellent pain relief in both the groups with good baby APGAR score. Conclusion: We conclude that 12ml of intermittent epidural boluses of 0.08% levobupivacaine and 0.1% ropivacaine with 2μg/ml fentanyl (equipotent dose) provided equal and effective analgesia during labour with comparable incidence of instrumental vaginal delivery.