Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial

Abstract

Background & Objective: Labor pain relief has been a challenge for the clinicians for centuries.  A lot many regimes and therapeutic interventions, including spinal and epidural injections, have been tried with variable effect. We aimed to compare the duration of analgesia and potency of bupivacaine plus fentanyl vs. levobupivacaine plus fentanyl for painless labor. Methodology: We enrolled 70 parturients who requested spinal analgesia in active labor, and randomly divided them into two groups; Group B (35 women) received 2.5 ml of bupivacaine 0.5% plus fentanyl 25 µg, and Group L (35 women) received 2.5 ml of levobupivacaine 0.5% plus fentanyl 25 µg. We assessed motor and sensory block, the efficacy of analgesia, pain scores, adverse effects, and obstetric and neonatal outcomes of both groups. Results: Time to reach maximum sensory block was significantly longer in Group L than in Group B (P = 0.002*). There was a statistically significant increase in the duration of motor blocks in Group B than in Group L (P < 0.05). The median VAS scores were significantly lower in Group L than in Group B after 2 and 3 h after injection. The duration of analgesia was significantly longer in Group L than in Group B (P < 0.05). The two study groups had no differences in the measured obstetric and neonatal outcomes. Conclusion: Levobupivacaine with fentanyl was superior to bupivacaine with fentanyl regarding the duration and potency of analgesia with lower pain scores, high maternal satisfaction, and no adverse obstetric or neonatal outcomes. Therefore, spinal levobupivacaine plus fentanyl was a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus. Key words: Bupivacaine; Fentanyl; Levobupivacaine; Labor pain; Spinal Analgesia Citation: Ali WN, Youssef HA, Abbas AM, Roshdy PE, ImbabyASS. Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial. Anaesth. pain intensive care 2023;27(4):478−484; DOI: 10.35975/apic.v27i4.2256 Received: July 29, 2022; Reviewed: April 19, 2023; Accepted: April 21, 2023