Epidural Labour Analgesia What's New: Comparison of 0.125% Ropivacaine-Dexmedetomidine versus 0.125% Levobupivacaine-dexmedetomidine

Background �Levobupivacine and Ropivacaine are newer local anaesthetics with effects similar to bupivacaine but with the advantages of reduced central nervous system and cardiovascular toxicity. The aim of this prospective study was to compare ropivacaine and levobupivacaine with dexmedetomidine as adjuvant with both, for epidural analgesia in labour regarding onset, quality, duration of analgesia, motor blockade, labour outcome and any adverse effect on foetus. Methods � Fifty parturients were randomly divided into two groups comprising of 25 partuients each. The patients in group I received 10 ml of 0.125 % ropivacaine with dexmedetomidine (0.5�g/kg) as initial dose and 8 ml of 0.125 % ropivacaine with 0.5�g/kg of dexmedetomidine as subsequent top up doses as and when required. Patients in group II recieved10 ml of 0.125 % levobupivacaine with dexmedetomidine (0.5�g/kg) as initial dose and 8 ml of 0.125 % levobupivacaine with dexmedetomidine (0.5�g/kg) as subsequent top up doses as and when required. The onset, duration and quality of analgesia, motor blockade and feto-maternal outcomes were studied. Results- All parturient had effective labour analgesia with no motor blockade observed in both the groups. Onset of analgesia was significantly faster (p=.022) in group II ( levobupivacaine + dexmedetomidine) as compared to group I ( ropivacaine + dexmedetomidine) with the mean time of onset of analgesia being 12.24�1.30 minutes in group I ( ropivacaine + dexmedetomidine) and 11.16�1.86 minutes in group II (levobupivacaine +dexmedetomidine). Mean VAS score were significantly less (p=0.046) in group II in 5, 10and 15 min. p value less than 0.05 The total duration of analgesia following the initial dose was 172.16�21.25 minutes whereas in group I, the mean duration of analgesia was 158.52�25.58 minutes. There was no significant difference in relation to motor blokcade, mode of delivery or fetal outcomes. Conclusion- We conclude that both the concentrations of levobupivacaine and ropivacaine along with adjuvant dexmeditomidine, both provide effective labour analgesia. However, levobupivacane was found superior in terms of faster onset, prolonged duration of action, lesser incidence of breakthrough pain requiring lesser top-ups, and hence a lesser consumption of drugs