A Comparative Study of Effectiveness of 0.125% Levobupivacaine with Fentanyl 2mcg/ml versus Levobupivacaine with Dexamethasone 4mg in Epidural Labor Analgesia

Abstract

Background: Epidural analgesia is widely accepted as the gold standard for pain relief during labor due to its superior efficacy and maternal satisfaction. Levobupivacaine, a safer alternative to bupivacaine, is often combined with adjuvants like fentanyl or dexamethasone to enhance its analgesic profile.

Objective: To compare the effectiveness and safety of 0.125% levobupivacaine with fentanyl 2 mcg/ml versus 0.125% levobupivacaine with dexamethasone 4 mg for epidural labor analgesia.

Methods: Sixty primigravida women in active labor were randomly divided into two groups: Group LF received 0.125% levobupivacaine with fentanyl 2 mcg/ml, and Group LD received 0.125% levobupivacaine with dexamethasone 4 mg. Parameters assessed included onset and duration of analgesia, total number of top-ups, maternal hemodynamic stability, motor blockade, maternal satisfaction, and neonatal APGAR scores.

Results: Both combinations provided effective labor analgesia. Group LF had a significantly faster onset of analgesia (7.93±1.01 vs 8.83± 0.70), longer duration of analgesia (90.03± 5.14 vs 58.37± 4.80), lesser total drug usage (30.42± 2.71 vs 39.17± 3.26) required fewer top-ups (2.87± 0.43 vs 4.27± 0.52) and less VAS scores with greater maternal satisfaction and fewer opioid related side effects. Hemodynamic parameters and neonatal outcomes were compared and major adverse effects were observed in either group.

Conclusion: Both regimens are safe and effective for epidural labor analgesia. However, the addition of fentanyl to levobupivacaine prolongs the duration of analgesia and reduces the need for additional doses, making it a valuable alternative to opioid-based combinations.