Determination of ideal Ropivacaine level for optimal pain management during labor

Both 0.1% and 0.2% Ropivacaine concentrations offer effective pain relief during labor without motor blockade, but 0.2% provides better pain control, though with some trade-offs.

To investigate the ideal concentration of Ropivacaine for programmed intermittent epidural boluses (PIEBs) to balance pain relief and motor function.

This randomized controlled trial recruited 104 American Society of Anesthesiologists [ASA] I parturients, aged 18 to 45, scheduled for vaginal labor and compared two Ropivacaine concentrations (0.1% and 0.2% with Fentanyl 2 μg/ml). Key outcomes included motor blockade (measured by the modified Bromage scale), pain relief (measured by the visual analog scale [VAS]), and various maternal and newborn parameters.

All the participants exhibited Bromage scores of 6, and anesthetic consumption was comparable in both groups. The 0.2% group experienced better pain relief and satisfaction as opposed to the 0.1% group, but had lower diastolic blood pressure, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores, and a less satisfactory extrusion stage as observed by the obstetrician.

Both 0.1% and 0.2% Ropivacaine provide effective pain management without motor blockade during labor. The 0.2% concentration offers superior pain relief but comes with minor drawbacks in blood pressure and newborn scores.