Pain relief during labor: which ropivacaine and sufentanil dose yields greatest benefit?

  • Cai S & al.
  • Clin Ther
  • 23 Dec 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • For pain during labor, a median effective concentration (EC50) of 0.09687% ropivacaine combined with sufentanil 0.3 mg/mL or 18.76 μg epidural sufentanil combined with 0.1% ropivacaine yields a significant benefit without serious adverse events (AEs).

Why this matters

  • Ropivacaine combined with low-dose sufentanil is the preferred drug for labor analgesia.
  • The ideal concentration of either drug was unknown because previous studies have yielded conflicting results.

Study design

  • Study of 60 women who received ropivacaine (0.1%) with sufentanil (0.3 mg/mL) for labor pain.
  • Outcome: EC50 and visual analogue scale (VAS) scores.
  • Funding: Shanghai Natural Science Foundation; others.

Key results

  • The EC50 values for epidural administration: 
    • Ropivacaine: 0.09687% (95% CI, 0.08944%-0.1043%). 
    • Sufentanil: 18.76 μg (95% CI, 13.5-24.48 μg).
    • Preanalgesia VAS scores were 8.13 for ropivacaine and 8.33 for sufentanil.
    • These scores had significantly decreased at the following times (all P<.0001 style="list-style-type:circle;">
    • 30 minutes after labor analgesia: 2.70 ropivacaine and 2.80 sufentanil.
    • 60 minutes after labor analgesia: 1.37 ropivacaine and 1.53 sufentanil.
    • Full dilation of cervix: 3.53 ropivacaine and 3.83 sufentanil.
    • Fetal delivery: 2.80 ropivacaine vs 3.30 sufentanil.
  • Event rates:
    • Nausea and vomiting: 16.7% with ropivacaine and 13.3% with sufentanil.
    • Pruritus: 3.3% for each.
  • Limitations

    • Small sample size.

    Coauthored with Chitra Ravi, MPharm