Levobupivacaine for labor analgesia

Background: Combined spinal-epidural analgesia has become the preferred technique for labor analgesia as it combines the benefits of both spinal analgesia and flexibility of epidural catheter. Study was carried out with the primary aim to compare levobupivacaine and ropivacaine with fentanyl in terms of onset and duration of sensory block and to know maternal and fetal outcome.

Materials and methods: In a prospective randomized double-blind study, 60 primipara of the American Society of Anesthesiologists health status Class I and II with singleton pregnancy in active stage of labor were randomly allocated into two groups of 30 each. Group A received 3 mg intrathecal levobupivacaine with 25 μg fentanyl followed by epidural top-ups of 14 ml of levobupivacaine 0.125% with fentanyl 30 μg whereas Group B received 4 mg intrathecal ropivacaine with 25 μg fentanyl followed by epidural top-ups of 14 ml of ropivacaine 0.2% with fentanyl 30 μg. Patients were monitored for sensory and motor block characteristics, hemodynamics, maternal and fetal outcome, side effects, and complications. These characteristics were analyzed using the "Chi-square tests" and "unpaired t-test."

Results: Onset of analgesia was rapid in Group A (4.72 ± 0.54 min) as compared to Group B (5.58 ± 0.49 min). Duration of analgesia was also prolonged in Group A (117.00 ± 11.86 min) as compared to Group B (90.17 ± 8.85 min). Patients remained hemodynamically stable and side effects, and complications were comparable in both groups.

Conclusion: Levobupivacaine with fentanyl leads to early onset and prolonged duration of analgesia as compared to ropivacaine with fentanyl during labor analgesia.