Motor blocks and operative deliveries with ropivacaine and fentanyl for labor epidural analgesia: A meta-analysis

Abstract

Aim: Aim of this study was to estimate the incidence of motor blocks, instrumental deliveries and cesarean deliveries with ropivacaine and fentanyl in epidural analgesia for labor and to identify factors affecting the outcomes. Methods: Electronic databases were searched for original research papers by using appropriate medical subject heading terms and keywords. Effect sizes of individual studies were pooled under random effects model to obtain weighted overall effect size/s. Metaregression analyses were performed to evaluate the factors affecting motor block and cesarean delivery incidences. Results: Thirty studies (2851 women; age 27.42 years [95% CI 26.56, 28.26]) were included. Concentrations of drugs (weighted average) were: 0.095% [0.08, 0.11] ropivacaine and 0.000215% [0.00018, 0.00025] fentanyl. Overall, incidences of motor blocks, instrumental deliveries and cesarean deliveries were 14.36% [13.47, 15.26]; 25.55% [22.38, 28.71] and 12.45% [11.17, 13.73], respectively. Maternal age was significantly positively associated with motor blocks as well as cesarean deliveries. Second stage of labor duration was also positively associated with motor block and instrumental delivery incidences. Cervical diameter at trial entry was significantly negatively associated with cesarean deliveries. Fentanyl concentration as well as total usage were associated negatively with instrumental delivery but positively with cesarean delivery incidence. Conclusion: Epidural analgesia for labor with ropivacaine and fentanyl is associated with the incidence of approximately 14% motor blocks, 25% instrumental deliveries and 12% cesarean deliveries. Age, duration of the second stage of labor, cervical dilatation at initiation of neuraxial analgesia and dose of fentanyl may affect obstetric outcome.