Local Anesthetics in Labor Epidurals

[heartICU]

Just looking to keep the clinical discussion going. I am doing my OB rotation now, and am almost a month into it. Something I have noticed (and this is purely anecdotal evidence from my call shifts) about the different agents we use:

Depending on the staff for the day, we use either ropivacaine or bupivacaine. If I use marcaine, I usually load them first with 10cc of either 0.25% marcaine with 50mcg of fentanyl or 25mcg of sufentanil (depending on staff) and then start an infusion of 0.0875% marcaine with 5mcg/ml fentanyl.

If I use ropivacaine, I load them with 10cc of 0.2% ropivacaine with 1mcg/ml sufentanil, and then start an infusion of the same solution.

Here is my observation...it seems like I end up doing a lot more C/S for FTP when I use the ropivacaine. Seems like even though they feel the contractions, their pushing ability is not the same as with marcaine. Anyone have any insight? (I am going to post this in the OB forum also and see if any L&D RNs have anything to say).

[Brenna's Dad]

In school, we were taught to give 5cc of LA for a 5 foot woman and then 1 cc per 2 inches of high thereafter. It wasn't long before this recipe got me into a little bit of trouble with high blocks in tall women. Nothing too serious, just low BP and having to give Ephedrine.

Nowdays, if I'm doing a pure epidural technique I will hardly ever give more than 5 or 6 cc with 100 mcg of Fentanyl. Of course, this is after the 3cc I give as a test dose.

Do you find Sufentanil provides any great pain relief? Off the top of my head, due to it's lipid solubulity it might work a little quicker.

Although I have never used Ropivicaine, I thought it was suppose to spare motor to a greater extent than Marcaine?

[athomas91]

we likewise don't use ropivicaine much at my current site - but it does have a propensity due to its isomerism (i believe) to block sensory to a greater extent than motor

some use it for "walking" epidurals where they are permitted...a whole different discussion...