Ambulatory labor epidural analgesia: Bupivacaine versus ropivacaine

Dilute concentrations of bupivacaine combined with fentanyl have recently been used to initiate labor epidural analgesia in an attempt to balance adequate analgesia and minimal maternal motorblockade. Similar concentrations of ropivacaine have not been evaluated. This prospective, randomized, double-blinded study was designed to compare the efficacy of 20 mL of either 0.08% bupivacaine plus 2 mu g/mL fentanyl or 0.08% ropivacaine plus 2 mu g/mL fentanyl to initiate ambulatory labor epidural analgesia. Forty nulliparous women in early (less than or equal to 5 cm) established labor received either 20 mt of 0.08% bupivacaine plus 2 mu g/mL fentanyl (BF) or 0.08% ropivacaine plus 2 mu g/mL fentanyl (RF) to initiate epidural analgesia. One woman (BF) required supplemental analgesia, and two (one BF and one RF) had visual analog scale scores > 0 but < 20 at 20 min. The time (mean +/-SD) to visual analog scale score = 0 was BF (n = 18):12.0 +/- 4.5 min and RF (n = 19): 12.4 +/- 4.0 min (P > 0.05). Spontaneous micturition was observed in 65% (13 of 20) BF compared with 100% (20 of 20) RF (P < 0.01), and ambulation was demonstrated in 75% (15 of 20) BF compared with 100% (20 of 20) RF (P < 0.03). The incidence of forceps delivery was 35% (7 of 20) BF compared with 10% (2 of 20) RF (P < 0.04). The results of this study indicate that dilute ropivacaine combined with fentanyl effectively initiates epidural analgesia while concurrently preserving maternal ability to void and ambulate.