On the ropivacaine-reducing effect of low-dose sufentanil in intrathecal labor analgesia

Combining ropivacaine with sufentanil for intrathecal (i.t.) analgesia in labor is well recognized, but information on dosing is limited. This study aimed to determine the ED 50 of i.t. ropivacaine and to assess the effect of adding defined low doses of sufentanil.

This was a two-phase, double-blind, randomized and prospective study. One hundred and fifteen parturients receiving combined spinal epidural analgesia were allocated to one of four groups to receive ropivacaine or sufentanil alone or in combination. In phase one, sufentanil dose-response was calculated using logistic regression. In phase two, ED 50 of ropivacaine and of the combination with a fixed dosage of sufentanil at ED 20 and ED 40 was evaluated using the technique of up-down sequential allocation. Analgesic effectiveness was assessed 15 min after injection using a 100 mm visual analog scale, with <10 mm lasting for 45 min defined as effective. Furthermore, side effects and duration were recorded.

The ED 50 of i.t. ropivacaine was 4.6 mg [95% confidence intervals (95% CI) 4.28, 5.31]. Adding sufentanil at ED 20 significantly decreased the ED 50 of i.t. ropivacaine to 2.1 mg (95%CI 1.75, 2.5) (P<0.005); at ED 40, the reduction was similar (P<0.005). Combining sufentanil with ropivacaine resulted in a dose-independent prolongation of analgesia. Besides pruritus, which was well tolerated, there were no differences in side effects.

Adding sufentanil at ED 20 results in a more than 50% dose-sparing effect of ropivacaine and considerably prolongs analgesia. Increasing dosage implicates no clinical benefit.