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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Patient controlled epidural anesthesia for labor: Bupivicaine vs. Ropivicaine, a meta-analysis

Abstract Number: F 32
Abstract Type: Meta Analysis/Review of the Literature

Christian G Samuelson MD1 ; Mical M Samuelson-Duvall MD2; Robert L Hermann MD3; Tomasina Parker MD4; Frank G Zavisca MD/PhD5

Patient controlled epidural anesthesia for labor: Bupivicaine vs. Ropivicaine, a meta-analysis

Introduction:

Bupivicaine has been widely available for many years for epidural anesthesia. It has been shown to be highly effective for sensory analgesia, however some patients developed unacceptable motor blockade at higher doses, which has the risk of prolonging labor. In addition there is also an associated risk of cardiovascular toxicity with unintentional IV bupivicaine injection. Since its introduction in 1996, Ropivicaine has gained popularity due to its decreased incidence of cardiovascular toxicity and greater selectivity of sensory fibers compared with bupivicaine(1). Despite these theoretical advantages, large studies have failed to show any advantage of ropivicaine over bupivicaine for any mode of epidural analgesia in laboring patients.

While this topic has been the subject of meta-analysis, most of these studies were large scale trials of continuous infusions. As such very little data exists comparing these two anesthetics for patient controlled epidural analgesia in laboring patients. The goal of this study was to:

1) Review the current literature reporting on the use of bupivicaine and ropivicaine for patient controlled analgesia in laboring patients.

2) To use meta-analysis to compare amount of anesthetic used, complications, motor blockade and anesthetic outcomes among these studies.

Methods:

A literature search was conducted of Pubmed, OVID and Cochrane databases for English language peer-reviewed publications comparing Bupivicaine to Ropivicaine for patient controlled epidural analgesia in laboring patients. Only prospective/randomized studies were included for review. Studies were combined using a random-effect meta-analysis and publication bias was evaluated.

Results:

Following PRISMA guidelines, 11 studies(1605 patients) were included for final analysis. There was no significant difference in the volume of anesthetic used, or the risk of hypotension, nausea and pruritis. While the odds ratio of having motor blockade was over 3 times higher in the patients receiving bupivicaine (p<0.001), there was no significant difference noted in patient satisfaction, duration of labor or mode of delivery. There was significant publication bias noted in reporting of motor blockade (p<0.05), however adding imputed studies does not significantly alter out results.

Conclusion:

While there is a significant difference in the incidence of motor blockade, the use of ropivicaine does not appear to offer any advantage, or decreased complications over bupivicaine. In addition, increased motor blockade does not appear to have any significant effect on maternal satisfaction, or the type and duration of labor.

1. Ropivicaine versus bupivicaine for epidural labor analgesia. Beilini, Y and Halpern, S. 2010, Anesth Analg, pp. 482-7.

SOAP 2013