Efficacy of spinal-epidural block with different doses of Sufentanil and Ropivacaine for labor analgesia in latent phase

Objective To evaluate the efficacy of spinal-epidural block with different doses of Sufentanil and Ropivacaine for labor analgesia in latent phase. Methods 80 cases of patients with ASA Ⅰ or Ⅱ primiparas with a singleton at full term in Beijing Amcare Hospital from April to September 2013 who were randomized into four groups, with 20 cases in each group, group R1(Ropivacaine 3 mg plus Sufentanil 3 μg), group R2(Ropivacaine 3 mg plus Sufentanil 4μg), group R3(Ropivacaine 3 mg plus Sufentanil 5 μg) and the control group R(Ropivacaine 3 mg). Patients received labor analgesia in latent phase(at cervical dilatation of 1 cm). Patient controlled epidural infusion of 0.1% Ropivacaine plus Sufentanil 0.5 μg/mL was administered in four groups. The intensity of pain was evaluated by NRS score, and the motor function was assessed using modified Bromage score. The labor process, mode of delivery, fetal HR, uterine contraction, postpartum hemorrhage, dosage of oxytocin, Apgar score of the neonates, maternal hemodynamics were recorded. Results The maternal vital signs were fluctuated in the normal range. Compared with before analgesia, NRS scores in the four groups were all significantly reduced(P 0.05). With the increasing of dosages of Sufentanil, the onset and working time of analgesia were reduced gradually(P 0.05), the lasting time of first dose was extended gradually(P 0.05). The dosages of PCEA consumed in latent phase of group R2 and R3 was less than that in group R(P 0.05). There were no significant differences in the dosages of PCEA consumed in active phase among the four groups(P 0.05). There were no significant differences in the stages of labor, dosages of oxytocin, vaginal amount of bleeding, constituent ratio of delivery mode, newborn Apgar scores and weight of the four groups(P 0.05). There were 5 cases of FHR declined(FHR≤100 times/min) after loading dose in group R3. The incidence of skin pruritus in group R was lower than the other three groups(P 0.05). The incidence of nausea was higher in group R3 than the other three groups(P 0.05). Maternal satisfaction in group R2 was better than the other three groups. Conclusion Spinal-epidural block with Ropivacaine 3 mg plus Sufentanil 3-5 μg for labor analgesia in latent phase is safe and effective. Ropivacaine 3 mg plus Sufentanil 4 μg is more suitable for labor analgesia with faster onset, longer hold time, lower incidence of complications and higher maternal satisfaction, which has some advantages in clinical application.