EFFICACY OF ROPIVACAINE WITH AND WITHOUT FENTANYL USING DURAL PUNCTURE EPIDURAL TECHNIQUE FOR LABOUR ANALGESIA–A RANDOMIZED DOUBLE BLINDED CLINICAL TRIAL

Abstract

Introduction:

            Neuraxial technique is considered the gold standard for labour analgesia. Ropivacaine has shown to produce less motor blockade than the bupivacaine. Addition of fentanyl to ropivacaine for epidural analgesia improve the efficacy and quality of analgesia. The present study was done to compare the effectiveness of intermittent boluses of 0.1% Ropivacaine (R)and 0.1% Ropivacaine with fentanyl (RF) by dural puncture epidural labour analgesia on quality of analgesia. 

Methodology:

            By continuous sampling enrolled 100 primigravida with singleton uncomplicated pregnancies who desired labour analgesia. CSE kit was used and dural puncture was performed after identification of epidural space, and needle was removed without administration of any drug. Group R received 0.1% ropivacaine 12ml while Group RF received the same drug as group R with 2mcg/ml fentanyl through epidural catheter as intermittent bolus. Onset, quality and duration of analgesia were the outcome measure. Mode of delivery, APGAR score, hemodynamic and any complications were noted.

Results:

            Quality of analgesia was comparable between two groups with 62% and 52% in R and RF respectively did not perceive any pain during uterine contraction (p- 0.59). Mean onset of analgesia in Group R and RF was 3.02 ± 0.68 min and 3.03 ± 0.85 min (p- 0.06) respectively. Duration of analgesia in Group R was 108.59 ± 63.70 min and in Group RF was 155.51 ± 118.1mins. 12% in group R and 22% in Group RF underwent caesarean section. Maternal and fetal HR and maternal DBP was high in R compared to RF group. APGAR was 8 at 1 min and 9 at 5 min in both the groups. None of the parturient had PDPH.

Conclusion:

            0.1% Ropivacaine is found to be comparable   and effective as ropivacaine with fentanyl in terms of onset and quality of analgesia, maternal and foetal outcome by dural puncture epidural technique.

Keywords: Dural puncture epidural, Ropivacaine, Fentanyl, labour analgesia.