Efficacy and safety of epidural or combined spinal-epidural labor analgesia with ropivacaine and fentanyl

Objective To compare the efficacy and safety of epidural or combined spinal-epidural labor analgesia with ropivacaine and fentanyl.Methods Forty nulliparous parturients with cervical dilation of 3-5 cm were randomly assigned to receive epidural (group CEA) or combined spinal-epidural analgesia (group CSEA) for labor analgesia with 20 cases each.Anather 20 nulliparous parturients without labor analgesia were taken as the controls.0.1% ropivacaine 5 ml plus fentanyl (2 μg/ml) was administered,which was followed by additional 10 ml injection in group CEA.Ropivacaine 2 mg plus fentanyl 10 μg was injected intrathecally in group CSEA.Patient controlled epidural infusion of 0.1% ropivacaine plus fentanyl 2 μg/ml was administered in two groups.Pain scores,lower extremity muscle strength,time of stages,delivery mode,dosage,maternal satisfaction,Apgar scores(1 min and 5 min),and concentrations of ropivacaine in umbilical cord blood were measured.Results VAS scores in groups of CSEA and CEA were lower than those in control group at all time points,which in group CSEA were lower than those in group CEA within 30 min after analgesia initiated.The consumptions of ropivacaine and fentanyl in group CSEA were less than those in group CEA(P0.05),but concentration of ropivacaine in umbilical cord blood was not statistically different between two groups.The first stage of labor in groups of CSEA and CEA was shorter than that in control group.Groups of CSEA and CEA had higher rates of vaginal delivery and oxytocin's use (P 0.05).Compared with group CEA,shorter onset,lower rate of oxytocin's usage,but higher rate of vaginal delivery and maternal satisfaction were seen in group CSEA (P 0.05). Conclusion Labor analgedia with CSEA or CEA is satisfied and safe.CSEA was more suit for labor analgesia in active stage with faster onse,lower consumption of drug and higher maternal satisfaction.