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

Background: 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. Materials and Methods: 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. Results: 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. Conclusion: Both levobupivacaine and ropivacaine are highly effective for labor analgesia using the combined spinal epidural (CSE) technique. Keywords: Labor analgesia, Ropivacaine, Levobupivacaine.