# Programmed Intermittent Epidural Boluses of 0.1% Ropivacaine Versus 0.2% Ropivacaine for the Maintenance of Epidural Analgesia in Labor

## TL;DR

This study compares two concentrations of ropivacaine for epidural analgesia during labor to find the best balance between pain relief and minimal side effects.

## Contribution

The study evaluates 0.1% versus 0.2% ropivacaine with fentanyl for epidural analgesia using programmed intermittent boluses.

## Key findings

- Both concentrations provided satisfactory analgesia without motor blockade.
- The 0.2% group experienced better pain relief and satisfaction.
- The 0.2% group had lower diastolic blood pressure and APGAR scores.

## Abstract

Objective

The gold standard for pain management during labor is epidural analgesia, which can be administered in two different ways to the parturients, either by bolus doses or continuous infusions of local anesthetic solutions with opioids. Recently, programmed intermittent epidural boluses (PIEBs) via a pump are gaining popularity as a very effective method with minimal side effects. The aim of this study was to evaluate the optimum ropivacaine concentration between two different regimens (0.1% or 0.2% both with fentanyl 2 μg/ml) that can provide satisfactory analgesia with the minimum degree of motor blockade, using PIEBs.

Methods

A prospective randomized controlled study was performed from March 2020 to March 2022. Two different concentrations of ropivacaine 0.1% and 0.2% via PIEBs were equally allocated to two groups of parturients with an additional patient control epidural rescue bolus if needed. Our primary endpoint was motor blockade, as assessed by the modified Bromage scale (MBS). We also recorded visual analog scale (VAS) scores, heart rate, blood pressure, total local anesthetic consumption, labor duration and method of delivery, and APGAR score of the newborns.

Results

All patients presented Bromage scores equal to 6, and the total consumption of the anesthetic solution was comparable between the two groups. Women in the 0.2% group showed higher pain relief and satisfaction compared to the 0.1% group. Concerning the 0,2% group, diastolic blood pressure and APGAR scores were lower alongside with a lower satisfactory extrusion stage observed by the obstetrician.

Conclusion

Both ropivacaine regimens provide satisfactory labor epidural analgesia for the expectant mother without any motor blockade.