Patient-controlled epidural analgesia with ropivacaine combined with fentanyl for labor

Objective To compare two methods of patient controlled epidural analgesia (PCEA) with 0 2% ropivacaine plus fentanyl 2μg·ml -1 with or without background infusion for labor Methods Ninety ASA Ⅰ Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentation and were expected to have vaginal delivery were randomly divided into three groups of 30 each: group A received PCEA without background infusion; group B received PCEA with background infusion and group C received no analgesia of any kind and served as control PCEA included a bolus of 4 ml with a 15 minute lock out When the primigravida was in first stage of labor, an intravenous line was established and 5% glucose normal saline 500 1000 ml was being infused When the external cervical os was dilated to 3 cm, epidural catheter was placed at L 2 3 and a test dose of 4 ml was given 5 min later when no signs of subarachnoid injection was evident, block height was tested by pinprick and another 6 ml was given 30 min later in group B background infusion of 0 2% ropivacaine + fentanyl 2μg·ml -1 was started at a rate of 4 ml·h -1 until the second stage of labor began Maternal vital signs (BP, ECG, SpO 2, P ET CO 2), VAS scores, degree of motor block, drug consumption, side effects of PCEA, gas analysis of umbilical venous blood, progress of labor, and Apgar scores were noted Venous blood samples were taken before PCEA and at the end of first stage of labor for determination of serum epinephrine and norepinephrine levels Results There were no significant differences in Apgar scores, blood gas of umbilical venous blood and the durations of first and second stage of labor among the three groups There were no differences in VAS scores, degree of sensory and motor block, serum concentrations of epinephrine and norepinephrine and percentage of cesarean section between group A and B The percentage of cesarean section was significantly higher in control group than that in group A and B Plasma NE and E concentrations at the end of the first stage of labor were significantly higher in control group than those in group A and B The ropivacaine and fentanyl consumption was less and the incidence of itching and percentage of instrumental delivery were lower in group A than those in group B Conclusions PCEA with 0 2% ropivacaine and fentanyl 2μg·ml -1 was safe and effective It reduces the percentage of cesarean section PCEA without background infusion provides the same level of analgesia as PCEA with background infusion with less drugs and side effects