Different Doses of Ropivacaine either with Sufentanil or with Dexmedetomidine for Labor Epidural Anesthesia regarding Painless Childbirth: A Retrospective, Multicenter Study

Abstract

<b><i>Introduction:</i></b> Sufentanil is used with ropivacaine in labor pain management but it can have respiratory depression. Dexmedetomidine is effective to maintain hemodynamic stability in parturient women and allow awake intubation. However, dexmedetomidine is suggested only in patients with major cardiovascular disease that mandates stable hemodynamics (Reference ID: 3987541-USFDA). The objective of the study was to compare different doses of ropivacaine either with sufentanil or with dexmedetomidine for epidural anesthesia regarding labor pain management. <b><i>Methods:</i></b> Parturient women have received 0.125% ropivacaine with 0.5-μg/mL sufentanil (SR1 cohort, <i>n</i> = 115), or 0.08% ropivacaine with 0.5-μg/mL sufentanil (SR2 cohort, <i>n</i> = 109), or 0.125% ropivacaine with 0.5-μg/mL dexmedetomidine (DR1 cohort, <i>n</i> = 124), or 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine (DR2 cohort, <i>n</i> = 135) for epidural anesthesia during vaginal delivery or cesarean section. <b><i>Results:</i></b> At 2-h postpartum, the visual analog scale score of parturient women of the DR2 cohort was fewer than that of parturient women of the SR1 (<i>p</i> &#x3c; 0.0001, <i>q</i> = 4.162) and the SR2 (<i>p</i> &#x3c; 0.0001, <i>q</i> = 7.568) cohorts and statistically the same as that of parturient women of the DR1 cohort (<i>p</i> &#x3c; 0.0001, <i>q</i> = 3.087). Bradycardia and itching were reported in parturient women of the DR2 and the DR1 cohorts while nausea, vomiting, and urinary retention at 6 h were reported in parturient women of the SR1 and the SR2 cohorts. In the DR2 cohort, there were fewer numbers of parturient women with bradycardia (4 vs. 19, <i>p</i> &#x3c; 0.0001, <i>q</i> = 6.613) and hypotension (2% vs. 1%) than those in the DR1 cohort. The child born by women of the DR2 cohort had high partial arterial pressure of oxygen than those born by women of the DR1 (<i>p</i> &#x3c; 0.0001, <i>q</i> = 18.663), the SR1 (<i>p</i> &#x3c; 0.0001, <i>q</i> = 29.366), and the SR2 (<i>p</i> &#x3c; 0.0001, <i>q</i> = 24.039) cohorts. <b><i>Discussion/Conclusion:</i></b> Epidural 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine is an effective and safe anesthetic regimen for hypertensive parturient women and their newborns. <b><i>Level of Evidence:</i></b> III. <b><i>Technical Efficacy Stage:</i></b> 4.