Comparison between different epidural analgesia modalities for labor

'Walking epidural': comparison of the analgesic efficacy of levobupivacaine 0.0625% + fentanyl 2mcg/mL versus ropivacaine 0.075% + fentanyl 2mcg/mL

INTRODUCTION

Epidural infusion with low local anesthetic concentrations with opiates decrease the severity of the motor blockade associated. The present study aims to compare the analgesic efficacy and the motor blockade between two local anesthetic epidural infusions: levobupivacaine 0.0625% + fentanyl 2mcg/mL versus ropivacaine 0.075% + fentanyl 2mcg/mL.

MATERIALS AND METHODS

In a single-blind prospective randomized study, 60 laboring parturient had continuous epidural analgesia as follows: 30 of them received levobupivacaine 0.0625% + fentanyl 2mcg/mL and 30 of them received ropivacaine 0.075% + fentanyl 2mcg/mL and rates of infusion were adjusted to the height. Analgesic, motor blockade and satisfaction records were collected as well as maternal and neonate adverse events.

RESULTS

After 2 h of the catheter placement, patients who received levobupivacaine showed a mean VAS of 3.2 [1.8-4.6] versus 1.8 [1.2-2.5] (p = 0.05) in patients who received ropivacaine. In addition, patients who received levobupivacaine showed a punctuation in Bromage scale of 0.0 [0.0-1.0] versus 0.0 [0.0-0.0] (p = 0.04) in patients who received ropivacaine. Finally, the parturient who received levobupivacaine scored a mean satisfaction index of 8.1 [7.3-8.9] versus 9.3 [8.7-9.8] (p = 0.02) in those who received ropivacaine. We did not register maternal nor neonate adverse events.

CONCLUSION

Both infusions (levobupivacaine 0.0625% + fentanyl 2mcg/mL and ropivacaine 0.075% + fentanyl 2mcg/mL) are effective for labor analgesia. However, ropivacaine would present a better pharmacodynamic profile with less motor blockade and decreased need for analgesic rescue hence improving patient's satisfaction.

Optimization of programmed intermittent epidural bolus volume for different concentrations of ropivacaine in labor analgesia: a biased coin up-and-down sequential allocation trial

Background and objectives

To date, programmed intermittent epidural bolus (PIEB) has been widely used in obstetric analgesia, while no optimal PIEB regimen has been proposed. This study aimed to assess effective analgesia in 90% of women (EV90) with different concentrations of ropivacaine (0.075% and 0.1%) combined with 0.5 µg/mL sufentanil, at an interval of 40 min using the biased coin design-up-and-down method (BCD-UDM), and to explore whether there is a difference in EV90 with the increase of ropivacaine concentration.

Methods

In total, 103 primiparous women were assigned to two groups, including group A (n = 52) and group B (n = 51). Parturients in group A were treated with 0.075% ropivacaine and 0.5 µg/mL sufentanil, while those in group B were treated with 0.1% ropivacaine and 0.5 µg/mL sufentanil. Used the biased coin up-and-down sequential allocation method to determine the EV90. The secondary outcomes were sensory block level, motor block, and adverse events (hypotension, urinary retention, and pruritus).

Results

The results revealed that EV90 was 10 mL (95% confidence interval (CI):8.03–11.54) in group A, and EV90 was 9 mL (95% CI:7.49–10.51) in group B by the isotonic regression method. The highest level of the sensory block was T8, and the lowest was T12. No case of hypotension was recorded,and only 4 parturients complained of motor block.

Conclusion

With an interval of 40 min, the optimal PIEB bolus volume of 0.075% ropivacaine and 0.5 µg/mL sufentanil was 10 mL, 0.1% ropivacaine and 0.5 µg/mL sufentanil was 9 mL. Moreover, the PIEB volume decreased along with the higher concentration of ropivacaine.

Trial registration

ChiCTR registration number: ChiCTR2000040917. Registration date: December 15, 2020.

Extending epidural analgesia for intrapartum cesarean section following epidural labor analgesia: a retrospective cohort study

Objective: To determine the effectiveness of extending epidural analgesia following epidural labor analgesia for intrapartum cesarean section, and provide a reference for clinical practice.Methods: Data of 1254 singleton parturient who failed trial of epidural labor analgesia and underwent intrapartum cesarean section were retrospectively included. After entering the operating room, parturient were given 3 ml of 1.5% lidocaine with 1:200,000 epinephrine 15 µg as a test dose, followed by a dose of 10 ml 0.75% ropivacaine plus 5 ml of 2% lidocaine mixed solution was administered via the epidural catheter. Case data were reviewed and analyzed of cesarean section anesthesia implementation methods, results and maternal and neonatal outcomes.Results: Of the 1254 parturient, 4.7% (59 of 1254) underwent general anesthesia directly, 7.1% (89 of 1254) were given combined spinal and epidural anesthesia, and the other 88.2% (1106 of 1254) underwent extending epidural anesthesia, 3.5% (39 of 1106) of them were given general anesthesia after extending epidural anesthesia failed, and 96.5% (1067 of 1106) parturient have a successful extending epidural anesthesia. Adverse reactions of extending epidural anesthesia: 6.7% (72 of 1067) parturient experienced hypotension and 12.1% (129 of 1067) of nausea and vomiting occurred. For the neonatal Apgar scores at 1 min, eleven of 1254 (0.9%) newborns were between 0 and 3 points, 107 (8.5%) newborns between 4 and 7 points, and 1136 (90.6%) newborns Apgar scores between 8 and 10 point. 24 (1.9%) newborns with Apgar scores between 4 to 7 points at 5 min transferred to the department of neonatology, and the rest 1230 (98.1%) newborns with Apgar scores 8-10 points.Conclusion: Extending epidural analgesia using the well-functioning epidural catheter for epidural labor analgesia might be a reliable and effective anesthetic method for intrapartum cesarean section.

Does epidural anesthesia influence pelvic floor muscle endurance and strength and the prevalence of urinary incontinence 6 weeks postpartum?

INTRODUCTION AND HYPOTHESIS

With the increasingly extensive application of epidural analgesia, its effect on pelvic floor function outcomes has received growing attention. The aim of the study is to determine the possible effect of epidural analgesia on pelvic floor muscle (PFM) endurance and strength and the prevalence of urinary incontinence (UI) and stress urinary incontinence (SUI) at 6 weeks postpartum.

METHODS

This is a retrospective cohort study of 333 primiparous women after vaginal delivery. At 6 weeks postpartum, a vaginal balloon connected to a high-precision pressure transducer was used to measure PFM strength and endurance. SUI/UI was determined using the verified Chinese International Classification of Urinary Incontinence Short Form (ICIQ-UI-SF) questionnaire. Statistical analysis was performed using binary logistic regression and multiple linear regression analysis.

RESULTS

Women in the epidural analgesia group experienced longer first and second stages of labor (p < 0.05). There were no statistically significant differences in the rates of perineal lacerations, forceps assistance or episiotomy between women with or without epidural analgesia (p > 0.05). No statistically significant differences were found in PFM endurance (B: 0.933, 95% CI confidence interval: -1.413 to 3.278, p: 0.435) or PFM strength (B: 0.044, 95% CI: -3.204 to 3.291, p:0.979) between these two groups. In addition, the prevalence of UI (30.77% vs. 26.87%) and SUI (21.54% vs. 16.42%) in women with or without epidural analgesia was not statistically significant (p > 0.05).

CONCLUSIONS

PFM function and UI prevalence at 6 weeks postpartum are not significantly affected by epidural analgesia.