A comparative study of low concentration of levobupivacaine versus bupivacaine with fentanyl for epidural analgesia in labour

Abstract

Introduction: Labour analgesia technique is the most widely practiced procedures of pain management performed by an anaesthesiologist and are requested by the obstetrician colleagues as well as the parturient mothers. It has been associated with maternal adverse effects like higher incidence of instrumental assisted vaginal delivery (AVD) and motor block leading to decreased ambulation. This study was designed to evaluate the efficacy of low concentrations of local anaesthetics (0.1% bupivacaine and 0.1% levobupivacaine) with 2µg/ml fentanyl as epidural analgesia.Materials and Methods: In this prospective study, 60 labouring parturients were randomly allocated into two groups to receive either 0.1% bupivacaine with 2 µg/ml fentanyl or 0.1% levobupivacaine with 2µg/ml fentanyl as epidural bolus after 10 ml loading dose of the respective solutions. The incidence of instrumental AVD demographic data, maternal and foetal vital parameters, maternal VAS scores, degree of motor blockade and total epidural drug consumption were studied. Results: The incidence of instrumental AVD was found to be equal in the levobupivacaine group and bupivacaine group. This difference was not statistically significant. Both groups were comparable in terms of demographic data, maternal VAS scores, total epidural drug consumption and foetal APGAR scores. Conclusion: The use of newer local anaesthetics (levobupivacaine and bupivacaine) in low concentrations with opioids (fentanyl) as epidural labour analgesia may offer high maternal satisfaction in terms of quality of pain relief with fewer adverse events like instrumental AVD and adverse foetal outcomes.