Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study

ABSTRACT Introduction Combined spinal–epidural analgesia to provide pain relief in labor has become the technique of choice. It provides benefits of both spinal analgesia and flexibility of an epidural catheter. In this study, we compared levobupivacaine with fetanyl and ropivacaine with fentanyl in terms of onset and duration of sensory blockade. Materials and methods This was a double-blind randomized study on 60 parturients of American Society of Anesthesiologists status 1 and 2, all primipara with singleton pregnancy in active labor, were allocated randomly into two groups of 30 each. Group L received 3 mg of levobupivacaine intrathecally with 25 µg fentanyl followed by epidural top-ups of 14 mL levobupivacaine 0.125% with fentanyl 30 µg, whereas group R received 4 mg of ropivacaine intrathecally with 25 µg of fentanyl followed by epidural top-ups of 14 mL ropivacaine 0.2% with fentanyl 30 µg. Sensory and motor characteristics, hemodynamics, maternal and fetal outcomes, side effects, and complications were observed and analyzed statistically using Student's unpaired t-test and chi-squared test. Results A rapid onset of analgesia in group L (4.67 ± 0.35) as compared with group R (5.57 ± 0.27) was observed. Duration of analgesia was also prolonged in group B (116.83 ± 6.91) as compared with group R (88.87 ± 5.10). Patients remained hemodynamically stable, and side effects and complications were comparable in both groups. Conclusion Levobupivacaine with fentanyl combination was found to be more promising in terms of onset and duration of labor analgesia as compared with ropivacaine and fentanyl combination. How to cite this article Sharma YK, Agrawal M. Combined Spinal–epidural with Levobupivacaine or Ropivacaine with Fentanyl for Labor Analgesia: A Comparative Study. Int J Adv Integ Med Sci 2017;2(2):73-77.

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Comparison of effects of low dose ropivacaine with levobupivacaine on quality of analgesia, maternal satisfaction and neonatal outcome during labor through combined spinal epidural approach: A double blind randomized study

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.045 ◽

2021 ◽

Vol 8 (2) ◽

pp. 230-235

Author(s):

Shruti Sharma ◽

Archana Agarwal ◽

Trilok Chand ◽

Unni Jithendran

Keyword(s):

Randomized Study ◽

Labor Analgesia ◽

Statistical Testing ◽

Secondary Outcome ◽

Epidural Administration ◽

Maternal Satisfaction ◽

Double Blind ◽

Combined Spinal Epidural ◽

Spinal Epidural

Regional techniques in labor analgesia have proven to be very effective, with bupivacaine being the most commonly used drug. This study compares the efficacy of local anaesthetics with lower cardiotoxicity and neurotoxicity such as levobupivacaine and ropivacaine in low doses, administered intrathecally followed by Patient Controlled Epidural Analgesia (PCEA). The primary outcome and secondary outcome of the study was to compare the quality of analgesia (verbal rating score) and maternal satisfaction respectively. The Double blind prospective randomized study included 60 parturients of ASA I and II with 37-41 weeks of singleton pregnancy in active labor, cervical dilatation >4 cm, with no obstetrical or medical complication, requesting painless labor, randomized into two groups (30 each) by a computer generated randomized sequence:Group R- received intrathecal 2.5 mg ropivacaine followed by epidural administration of 10 ml 0.125% ropivacaine Group L- received intrathecal 2.5 mg levobupivacaine followed by epidural administration of 10 ml 0.125% levobupivacaine. The primary and secondary outcome of the study was to compare the quality of analgesia and maternal satisfaction respectively. Statistical testing was conducted with the statistical package for social science system version (SPSS) 17.0. Group R had late onset and shorter duration of action with lesser motor blockade, however the results were statistically insignificant. Group L had slightly less total consumption of local anaesthetic and better maternal satisfaction, but was statistically insignificant. Patients in both groups had statistically similar pain scores at various intervals. Both levobupivacaine and ropivacaine are highly effective for labor analgesia using the combined spinal epidural (CSE) technique.

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Nalbuphine versus dexmedetomidine for treatment of combined spinal-epidural post-anesthetic shivering in pregnant women undergoing cesarean section

Journal of International Medical Research ◽

10.1177/0300060519865063 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4442-4453 ◽

Cited By ~ 1

Author(s):

Jing Sun ◽

Zhao Zheng ◽

Yi-Lu Li ◽

Li-Wei Zou ◽

Ge-Hui Li ◽

...

Keyword(s):

Cesarean Section ◽

Pregnant Women ◽

Epidural Anesthesia ◽

Randomized Study ◽

Saline Group ◽

Elective Cesarean Section ◽

Double Blind ◽

Combined Spinal Epidural ◽

Combined Spinal Epidural Anesthesia ◽

Spinal Epidural

Objective This study aimed to compare the clinical efficacy and side effects of nalbuphine and dexmedetomidine for treatment of combined spinal-epidural anesthetic shivering in women after cesarean section. Methods A total of 120 pregnant women, who underwent elective cesarean section under combined spinal-epidural anesthesia, were enrolled in a double-blind, randomized study. These women were randomized into three groups of 40 pregnant women each to receive either saline (group C), nalbuphine 0.07 mg/kg (group N), or dexmedetomidine 0.5 µg/kg (group D) for treatment of shivering after anesthesia. The main outcome measure was a significant reduction in the time required for shivering after intervention. Results The mean time to cessation of shivering in groups N and D was significantly shorter than that in group C (3.5±2.7 and 4.2±3.7 versus 14.5±1.4 minutes). The success rate of shivering treatment and Observer’s Assessment of Alertness/Sedation scores in groups N and D were significantly higher than those in group C, while the recurrence rate was lower than that in group C. Conclusion Nalbuphine 0.07 mg/kg can be used safely and effectively for shivering in pregnant women under combined spinal-epidural anesthesia.

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Dural Puncture with a 27-Gauge Whitacre Needle as Part of a Combined Spinal–Epidural Technique Does Not Improve Labor Epidural Catheter Function

Anesthesiology ◽

10.1097/00000542-200511000-00019 ◽

2005 ◽

Vol 103 (5) ◽

pp. 1046-1051 ◽

Cited By ~ 43

Author(s):

John A. Thomas ◽

Peter H. Pan ◽

Lynne C. Harris ◽

Medge D. Owen ◽

Robert D’Angelo

Keyword(s):

Epidural Catheter ◽

Drug Administration ◽

Dural Puncture ◽

Labor Analgesia ◽

Replacement Rate ◽

Sensory Blockade ◽

Combined Spinal Epidural ◽

Unilateral Block ◽

Spinal Epidural ◽

Catheter Function

Background This prospective, double-blind, randomized study was designed to examine whether the combined spinal-epidural technique without subarachnoid drug administration improved epidural catheter function when compared with the traditional epidural technique. Methods After institutional review board approval and informed consent, 251 healthy laboring parturients were randomly assigned to either group DP (combined spinal-epidural technique with 27-gauge Whitacre needle dural puncture but without subarachnoid drug administration) or group NoDP (traditional epidural technique). Patient-controlled epidural analgesia was initiated with 0.11% bupivacaine and 2 microg/ml fentanyl. Top-up doses in 5-ml increments of 0.25% bupivacaine were administered if needed. Previous power analysis revealed that a sample size of 108 patients/group was needed to show a clinically useful reduction of the catheter manipulation rate from 32% to 15%. Results In groups DP and NoDP, 107 and 123 evaluable patients, respectively, completed the study. Demographics and outcome variables measured, including epidural catheter manipulation and replacement rate, sacral sparing, unilateral block, number of top-up doses, average hourly epidural drug usage, highest sensory blockade level, and labor analgesia quality, were not different between groups. A subgroup of 18 patients without cerebral spinal fluid return during dural puncture had a higher catheter replacement rate than those of groups DP and NoDP, but it did not reach statistical significance. Conclusions Dural puncture with a 27-gauge Whitacre needle without subarachnoid drug administration during combined spinal-epidural labor analgesia did not improve epidural labor analgesia quality or reduce catheter manipulation or replacement rate when compared with a traditional epidural technique.

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Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques

Anesthesia & Analgesia ◽

10.1213/ane.0000000000001798 ◽

2017 ◽

Vol 124 (2) ◽

pp. 560-569 ◽

Cited By ~ 50

Author(s):

Anthony Chau ◽

Carolina Bibbo ◽

Chuan-Chin Huang ◽

Kelly G. Elterman ◽

Eric C. Cappiello ◽

...

Keyword(s):

Side Effects ◽

Dural Puncture ◽

Labor Analgesia ◽

Combined Spinal Epidural ◽

Dural Puncture Epidural ◽

Spinal Epidural

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Ambulatory Combined Spinal-Epidural Analgesia for Labor: Influence of Epinephrine on Bupivacaine-Sufentanil Combination

Regional Anesthesia The Journal of Neural Blockade in Obstetrics Surgery & Pain Control ◽

10.1136/rapm-00115550-199722020-00007 ◽

1997 ◽

Vol 22 (2) ◽

pp. 143-149

Author(s):

Philippe E. Gautier ◽

François Debry ◽

Luc Fanard ◽

Albert Van Steenberge ◽

Jean-Luc Hody

Keyword(s):

Motor Block ◽

Randomized Study ◽

Sensory Block ◽

Cervical Dilation ◽

Double Blind ◽

Late Side Effect ◽

Combined Spinal Epidural ◽

Block Level ◽

Spinal Epidural ◽

Late Side

Background and ObjectivesSubarachnoid sufentanil 5 μg during labor is known to have variable results. However, subarachnoid sufentanil 5 μg plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 μg to this mixture.MethodsForty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 μg and bupivacaine 1 mg with or without epinephrine 25 μg. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted.ResultsAddition of epinephrine prolonged the duration of analgesia from 103.8 ± 28.2 minutes to 142 ± 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group.ConclusionsThis minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 ± 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.

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Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 μg vs Sufentanil 5 μg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0001 ◽

2016 ◽

Vol 1 (1) ◽

pp. 1-4

Author(s):

Sanjeeta R Umbarkar ◽

Manju N Gandhi ◽

Hemlata R Iyer ◽

Roshan S Thawale

Keyword(s):

Side Effects ◽

Lower Limb ◽

Motor Block ◽

Demographic Data ◽

Double Blind Study ◽

Efficacy And Safety ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Combined Spinal Epidural ◽

Spinal Epidural

ABSTRACT Aim To compare the efficacy and safety of intrathecal fentanyl 20 μg vs sufentanil 5 μg as adjuvant to bupivacaine 0.5% (12.5 mg) using combined spinal epidural (CSE) technique for lower limb orthopedic surgeries. Background Use of local anesthetics along with opioids intrathecally has been widely reported. We aimed to compare two commonly used opioids as adjuvants to local anesthetic agents in combined spinal epidural techniques. Materials and methods A total of 60 patients were recruited in this prospective, randomized, double-blind study to receive either intrathecal sufentanil 5 μg (Group S) or fentanyl 20 μg (Group F) as adjuvants to 12.5 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block and the pain scores were assessed perioperatively. Duration of analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering. and postdural puncture headache (PDPH) were recorded. Results Demographic data and hemodynamic and respiratory parameters were comparable in both the groups. Onset of analgesia—time to reach highest level of analgesia—was faster in the sufentanil group. Sufentanil group patients had higher grade of motor block. Patients in fentanyl group had higher score of sedation than those of sufentanil group. None of the patients in any group had nausea, vomiting, or pruritus. Conclusion Addition of either fentanyl or sufentanil to intrathecal bupivacaine as an adjuvant in CSE technique enhances the quality of analgesia and motor block with minimal side effects. Hence, this is useful in orthopedic patients, especially in the geriatric age group. How to cite this article Umbarkar SR, Gandhi MN, Iyer HR, Thawale RS. Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 μg vs Sufentanil 5 μg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries. Res Inno Anaesth 2016;1(1):1-4.

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