A double-blind comparison of 0.125% ropivacaine with sufentanil and 0.125% bupivacaine with sufentanil for epidural labor analgesia

Background This study intends to evaluate the benefits of the administration of intermittent bolus doses of ropivacaine (0.125%) compared with bupivacaine (0.125%) after addition of sufentanil for analgesia during labor. Methods: One hundred thirty American Society of Anesthesiologists physical status 1 or 2 parturients were studied. The 90 initial patients were assigned randomly to receive 10 mi bupivacaine, 0.125%, plus 7.5 mu g sufentanil (initial bupivacaine 0.125% group) or ropivacaine, 0.125%, plus 7.5 mu g sufentanil (ropivacaine 0.125% group). Forty additional patients were recruited and received 0.125% bupivacaine plus 7.5 mu g sufentanil (additional bupivacaine 0.125% group) or 0.100% bupivacaine plus 7.5 pg sufentanil (additional bupivacaine 0.100% group). The duration of analgesia, visual analogue scores for pain, motor blockade (using a six-point modified Bromage scale), patient satisfaction scores, nausea, pruritus, heart rate, and blood pressure were recorded. Results: Bupivacaine 0.125% and ropivacaine 0.125% coadministered with sufentanil provided rapid and complete analgesia. Onset of analgesia occurred after +/- 15 min and lasted +/- 90 min. After the third epidural injection, patients in the ropivacaine group experienced significantly less severe motor blockade than patients in the initial bupivacaine 0.125% group. At this point, 93% of the patients in the ropivacaine group were free from motor impairment versus 66% in the bupivacaine group (P < 0.05). Comparable levels of motor blockade were obtained in both additional groups. Patients' evaluation of their analgesia was worst in the bupivacaine 0.100% group. Conclusions: Ropivacaine 0.125% with sufentanil affords reliable analgesia with minimal motor blockade

Intrathecal clonidine combined with sufentanil for labor analgesia

Background: Intrathecal sufentanil provides rapid-onset and complete analgesia for the first stage of labor, The dose required to produce this effect can be associated with maternal respiratory depression, hypotension, nausea, or pruritus. Because clonidine potentiates the analgesic effects of opioids without increasing their side effects, the authors wanted to determine the efficacy of low doses of intrathecal clonidine (15 and 30 mu g) combined with sufentanil. Methods: Ninety-eight parturient requesting labor analgesia were studied. In a combined spinal-epidural technique, patients mere randomly assigned to receive one of the following intrathecal solutions: either 15 mu g clonidine (n = 10); 30 mu g clonidine (n = 10); 2.5 mu g sufentanil (n = 13); 5 mu g sufentanil (n = 13); 2.5 mu g sufentanil and 15 mu g clonidine (n = 13); 2.5 mu g sufentanil and 30 mu g clonidine (n = 13); 5 mu g sufentanil and 15 mu g clonidine (n = 13); or 5 mu g sufentanil and 30 mu g clonidine (n = 13). Visual analog scores for pain, blood pressure, heart rate, sensory levels, incidence of nausea and pruritus, and motor blockade, and maternal and cord blood concentrations of clonidine were recorded. Results: patients receiving 30 mu g intrathecal clonidine with 2.5 or 5 mu g intrathecal sufentanil had significantly longer-lasting analgesia (145 +/- 36 and 145 +/- 43 min vs. 104 +/- 35 for those receiving 5 mu g intrathecal sufentanil alone). Clonidine levels were undetectable in maternal serum. Conclusions: Thirty micrograms of intrathecal clonidine combined with 2.5 or 5 mu g intrathecal sufentanil significantly increased the duration of analgesia during the first stage of labor without adverse maternal or fetal effects

Intrathecal ropivacaine for ambulatory surgery - A comparison between intrathecal bupivacaine and intrathecal ropivacaine for knee arthroscopy

Background The rationale of this study was to evaluate intrathecal ropivacaine for ambulatory surgery. Methods: One hundred fifty patients with American Society of Anesthesiologists physical status 1 scheduled for knee arthroscopy were studied. Patients were randomly assigned to receive 4 ml of one of five isobaric intrathecal solutions: Patients in group 1 (n = 30) received 8 mg of bupivacaine; patients in group 2 (n = 30) received 8 mg ropivacaine; patients in group 3 (n = 30) received 10 mg ropivacaine; patients in group 4 (n = 30) received 12 mg ropivacaine; and patients in group 5 (n = 30) received 14 mg ropivacaine. The level and duration of sensory anesthesia were recorded along with the intensity and duration of motor block. Patients were interviewed to identify transient neurologic symptoms. Results: Intrathecal ropivacaine 10 mg produced shorter sensory anesthesia and motor blockade than bupivacaine 8 mg (152 +/- 44 min and 135 +/- 41 min vs. 181 +/- 44 min and 169 +/- 52 min, mean +/- SD; P < 0.05). However, the quality of intraoperative analgesia was significantly lower in the 10-mg ropivacaine group (P < 0.05). Ropivacaine 12 mg produced sensory and motor block almost comparable to bupivacaine 8 mg. Ropivacaine 14 mg produced sensory and motor block comparable to ropivacaine 12 mg but significantly increased the time to void. No sign of transient radicular irritation mere noted. Conclusion: Intrathecal ropivacaine 12 mg is approximately equivalent to bupivacaine 8 mg. At this dose, ropivacaine offers no significant advantage compared with bupivacaine