Effective concentration of levobupivacaine and ropivacaine in 80% of patients receiving epidural analgesia (EC80) in the first stage of labour: A study using the Continual Reassessment Method - 19/09/18
, Marie-Pierre Bonnet c, d, e, f, Thomas Leclerc g, Jean-Xavier Mazoit b, Dan Benhamou b, Frédéric J. Mercier aBienvenue sur EM-consulte, la référence des professionnels de santé.
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Abstract |
Background |
A comparison of the effective dose in 50% of patients (ED50) has suggested that the potency of levobupivacaine lies between that of bupivacaine and ropivacaine. However, for clinical purposes, knowledge and use of doses close to the ED95 are more relevant. This study was designed to determine the EC80 (effective concentration) for both epidural levobupivacaine and ropivacaine using the Continual Reassessment Method (CRM) during obstetric analgesia.
Methods |
In this double-blind randomised study, term parturients were included by cohorts of 6 if cervical dilatation was≤5cm and visual analogue pain score (VAPS)>30mm. Efficacy was defined by a decrease of VAPS to a value≤10, thirty minutes after epidural injection of 20mL of levobupivacaine or ropivacaine. The first cohort received the lowest dose. Every next cohort received a dose according to the response's probability calculated using a Bayesian method, incorporating data from all consecutive previous patients. In addition, a logistic equation was fitted a posteriori to the whole data set to determine the whole dose-probability curve.
Results |
Fifty-four patients were enrolled. Levobupivacaine 0.17% and ropivacaine 0.2% gave probabilities of success of 82% and 72% respectively. By fitting the logistic model to the data, the concentration leading to a probability of 0.8 (EC80) was 0.14% for levobupivacaine and 0.24% for ropivacaine while the EC50 were 0.09% for levobupivacaine and 0.17% for ropivacaine, respectively.
Conclusion |
This study suggests that epidural levobupivacaine used as the sole drug for labour analgesia has an EC80 lower than that of ropivacaine.
Le texte complet de cet article est disponible en PDF.Keywords : EC80, MLAC, Continual Reassessment Method, Epidural analgesia, Labour, Levobupivacaine, Ropivacaine
Plan
| ☆ | This paper has been presented as an abstract at the ESA congress in June 2010, and the SFAR congress in September 2007. |
Vol 37 - N° 5
P. 429-434 - octobre 2018 Retour au numéro
Article précédent
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