Abstract
Purpose
To compare the effect on the incidence of motor block by reducing the concentration of ropivacaine from 0.2% to 0. 125% in parturient-controlled epidural analgesia (PCEA) for labour.
Methods
Randomized, controlled and double-blind trial involving parturients in early labour who received demand-only PCEA regimen (bolus 5 ml, lockout 10 min, maximum volume per hour of 20 ml) with either 0.2% (R0.2 group, n = 25) or 0. 125% (R0. 125 group, n=25) ropivacaine. Pain scores, the degree of motor block, the rate of drug consumption, the proportion of good to total PCEA demands and the overall satisfaction scores were documented,
Results
Fewer parturients in the R0. 125 group had lower limb motor block (4 vs 11, P < 0.05) although the degree of block was mild in all the affected parturients. The ratio of good to total PCEA demands was more favourable in the R0.2% group (median 0.72 vs 0.52, P < 0.01) although the hourly rate of ropivacaine consumption, the degree of pain relief, the maternal-fetal outcome and the overall satisfaction scores were similar. Conclusion: Both ropivacaine 0.2% and 0. 125% provided comparably effective analgesia but motor block occurred more commonly in the 0.2% group.
Résumé
Objectif
Comparer l’effet, sur l’incidence du blocage moteur, de la réduction de la concentration de ropivacaïne de 0,2 % à 0, 125 % pendant l’analgésie épidurale contrôlée par la patiente (AECP) en travail obstétrical.
Méthode
On a procédé à un essai randomisé, contrôlé et à double inconnu auprès de parturientes, au début de leur travail, qui ont reçu un régime d’AECP sur demande seulement (un bolus de 5 ml, une période réfractaire de 10 min, un volume maximal de 20 ml à l’heure) avec, soit de la ropivacaïne à 0,2 % (groupe R0.2, n = 25), soit à 0, 125 % (groupe R0. 125, n = 25). On a documenté: les scores de douleur, l’intensité du blocage moteur, la fréquence de la prise de médicament, la proportion de demandes efficaces sur les demandes totales d’AECP et l’indice de satisfaction globale.
Résultats
Peu de patientes du groupe R0. 125 ont eu un blocage moteur des membres inférieurs (4 vs 11, P < 0,05) bien que le blocage n’ait pas été important chez les parturientes touchées. La proportion de demandes efficaces sur les demandes totales d’AECP a été meilleure dans le groupe R0.2 % (médiane de 0,72 vs 0,52, P < 0,01), mais la fréquence horaire de consommation de ropivacaïne, le degré de soulagement de la douleur, l’évolution fœto-maternelle et la satisfaction globale ont été similaires.
Conclusion
La ropivacaïne 0,2 % et 0, 125 % produisent des effets analgésiques comparables, mais le blocage moteur survient plus souvent avec une concentration de 0,2 %.
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Sia, A.TH., Ruban, P., Chong, J.L. et al. Motor blockade is reduced with ropivacaine 0.125% for parturient-controlled epidural analgesia during labour. Can J Anesth 46, 1019–1023 (1999). https://doi.org/10.1007/BF03013195
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DOI: https://doi.org/10.1007/BF03013195