POTENTIATION OF EPIDURAL LABOUR ANALGESIA USING CONCOMITANT ROPIVACAINE AND FENTANYL BY TWO DOSES OF NEOSTIGMINE

Background: Local anesthetics have been used as a cornerstone to induce and maintainneuroaxial analgesia during labour 1). The epidural analgesia can provide a continuous andselective sensory block with minimal motor blockade, allowing parturient to ambulate safelyduring labor, in addition to the availability of the epidural catheter for surgical anesthesia if needed. Purpose: The study is aimed to evaluate the efficacy and the local anesthetic sparing effects of ropivacine combined with fentanyl and/or different doses of neostigmine for epidural analgesia during labour. Methods: 60 healthy parturients (ASA I or II physical status) primigravida with uncomplicated pregnancy. The parturients were randomly allocated into 3 groups (20 each), RF Group: Parturient received epidural ropivacine 0.1% in a dose of l0ml, and fentanyl (100^g), RFN500 Group: Parturient received epidural ropivacine 0.1%% a dose of 10mL and fentanyl (100^g) combined with neostigmine (500^g), and RFN750 Group: Parturient received epidural ropivacine 0.1% in a dose of 10ml compined wih fentanyl (100^g) and neostigmine in a dose 750^g. Patient-controlled epidural analgesia with ropivacaine 0.1% was used for epidural supplementation at a rateof 7mL /hour all over the labour stages. Assessment of the sensory level by using (brush test)and the motor block in the lower limb by (modified Bromage scale). Pain assessment wasdone by use of VAS score. The duration of analgesia, total dose of local anesthetic consumption, blood pressure, heart rate, and oxygen saturation was recorded throughout the course of labour. Uterine contractions were recorded every 30min during labour by cardiotocograph. Patient satisfaction, maternal complications (incidence of instrumental delivery) and non maternal complications was recorded. Results: 60 patients completed the study and were randomized into three groups. Addition of neostigmine to the combination of ropivacaine and fentanyl for epidural analgesia prolong the duration of analgesia (2.93±0.88hrs) and require less total amount of ropivacaine all over the procedure. It was found that the median range of (VAS) changes significantly across time in groups RFN500 and RFN750 versus RF Group. The incidence of motor block was lower in the RF group than other groups during the whole study without significant effect on neonatal outcome in all studied groups. Heart rate, systolic and diastolic blood pressure) changes showed significant decease after 5min in RFN500 and RFN750 Groups compared to RF group(control group). Conclusion: Ropivacaine is a safe local anesthetic for labor epidural analgesia when combined with fentanyl in a dose of 100^g and neostigmine in a dose of 500 or 750^g. This combination provided long lasting and consistent analgesia, excellent satisfaction without any maternal or fetal side effects. The study conclude that 500^g of neostigmine is effective epidurally as 750^g, that indicats no need for high doses of neostigmine.