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New amide local anaesthetics for obstetric use
E M Yun1, W Meadows, A C Santos
1Department of Anesthesiology, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY 10461, USA.
Bailliere'S Clinical Obstetrics and Gynaecology
|February 19, 1999
Summary
Newer local anesthetics like ropivacaine and levobupivacaine offer improved safety for obstetric anesthesia compared to bupivacaine. Further cost-benefit analyses are needed to determine their widespread clinical use.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Bupivacaine is the standard local anesthetic in obstetric anesthesia.
- It has a narrow safety margin compared to other agents.
- Single-isomer drug formulations are now clinically available.
Purpose of the Study:
- To compare the safety and efficacy of newer local anesthetics with bupivacaine in obstetric anesthesia.
- To evaluate the potential benefits of single-isomer formulations.
Main Methods:
- Review of clinical efficacy and safety data for ropivacaine and levobupivacaine.
- Comparison with existing bupivacaine formulations.
- Consideration of cost-benefit analyses.
Main Results:
- Ropivacaine and levobupivacaine show similar efficacy to bupivacaine.
- These newer agents possess a greater margin of safety.
- Levobupivacaine, the levo stereoisomer, exhibits lower systemic toxicity potential.
Conclusions:
- Ropivacaine and levobupivacaine represent safer alternatives in obstetric anesthesia.
- Their higher cost necessitates detailed cost-benefit analyses for future role definition.
- Further research is needed to establish their definitive place in obstetric care.