A Comparative Study of 0.15% Bupivacaine with Tramadol and 0.15% Ropivacaine with Tramadol for Epidural Labour Analgesia
Keywords:
Labor analgesia, epidural, local anaesthetics, opiodsAbstract
Providing safe and effective pain relief during labor without compromising on the mother and fetus has always been a challenging task for the anaesthetist. The introduction of concept of low concentration of local anaesthetics has allowed ambulation, besides providing pain relief and nonetheless, decreased the incidence of unpleasant side effects such as motor blockade. Ropivacaine is a newer alternative to bupivacaine, with greater sensorimotor differentiation, thus producing less motor blockade in comparison to bupivacaine. The purpose of this study was to evaluate the efficacy of Ropivacaine 0.15% when administered epidurally for the relief of labour pain and to compare it with 0.15% bupivacaine, with tramadol used as an adjunct in both the groups. The study was conducted on 20 healthy parturients after ethical approval from the institutional review board and obtaining written informed consent. Participants were randomly allocated to the two groups (bupivacaine 0.15% + tramadol 2mg/ml versus ropivacaine 0.15% + tramadol 2mg/ml). It was observed that both the local anaesthetic agents provided comparable analgesia without significant side effects at such low concentrations. There were no statistically significant differences in the total amount of local anaesthetic used, pain scores, motor blockade, duration of labor, mode of delivery, side effects and patient satisfaction amongst the two local anaesthetic groups using the intermittent top-up technique. We conclude that the combinations of ropivacaine or bupivacaine with tramadol achieve equally effective labor analgesia without compromising on the margin of safety and, hence, are recommended for labor analgesia.
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