Analgesic efficacy of two concentrations of bupivacaine in women in labor: Randomized, controlled, triple blind clinical trial

  • Ricardo Rodríguez-Ramón Hospital General de Zona Núm. 1, Instituto Mexicano del Seguro Social (IMSS), Campeche, Mexico
  • Horacio Márquez-González Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
  • María Valeria Jiménez-Báez Research in Health and Health Provision Services, Delegación Estatal IMSS, Quintana Roo, Mexico
  • Ilse Cristina Iparrea-Ramos Hospital General Regional Núm. 17, IMSS, Quintana Roo, Mexico
Keywords: Pain, Analgesia, Epidural, Bupivacaine, Labor obstetric


Introduction: Epidural analgesia is the safest and most effective method for the treatment of pain during childbirth. Epidural bupivacaine provides excellent analgesia for labor and remains the most widely used local anesthetic in obstetric anesthesia.

Objective: To evaluate the analgesic efficacy of two concentrations of bupivacaine in women in labor.

Methods: 114 patients in labor with term pregnancy were included in the study They were grouped randomly into two groups: patients who received bupivacaine at 0.125% (group A) and those who received 0.25% bupivacaine (group B). Patients in group A received a bolus injection of 10 ml of 0.125% bupivacaine. The patients in group B received a bolus of 10 ml bupivacaine 0.25%. Pain intensity according to VAS, blood pressure, heart rate, respiratory rate, and the degree of motorblock was assessed usingthe Bromage scale at different periods of time.

Results: Demographic characteristics and parity were compared with no statistically significant differences found. By comparing the values of the VAS measure at 0, 15, 30, 60 and 90 min, statistically significant differences in favor of the group with 0.25% bupivacaine were found with decreased pain perception after 30 min, p-value = 0.02. No differences in arterial pressure, heart rate and respiratory rate were found between the two groups.

Conclusion: The concentration of 0.25% bupivacaine has greater analgesic efficacy compared to 0.125% bupivacaine.


1. Lally J, Murtagh M, Macphail S, Thomson R. More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour. BMC Med. 2008;6:7.
2. Reitman E, Conell-Price J, Evansmith J, Olson L, Drosinos S, Jasper N, et al. β2-Adrenergic receptor genotype and other variables that contribute to labor pain and progress. Anesthesiology. 2011;114:927.
3. Rivera-Diaz R, Lopera-Rivera A. Manejo del dolor no obstétrico durante el embarazo Artículo de revisión. Rev Colomb Anestesiol. 2012;40:213-23.
4. Howell CJ, Kidd C, Roberts W, Upton P, Lucking L, Jones PW, et al. A randomised controlled trial of epidural compared with non-epidural analgesia in labour. BJOG. 2001;108:27-33.
5. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798-804.
6. Gogarten W, Van Aken H. A century of regional analgesia in obstetrics. Anesth Analg. 2000;91:773-5.
7. Marucci M, Cinnella G, Perchiazzi G, Brienza N, Fiore T. Patient-requested neuraxial analgesia for labor: impact on rates of cesarean and instrumental vaginal delivery. Anesthesiology. 2007;106:1035-45.
8. Raja S, Meyer R, Campbell A. Peripheral mechanisms of somatic pain. Anesthesiology. 1988;68:571-90.
9. González-Cárdenas VH, Munar-González F, Gómez-Barajas W, Cardona MA, Rosero BR, Manrique AJ. Remifentanilo vs analgesia epidural para el manejo del dolor agudo relacionado con el trabajo de parto Revisión sistemática y meta-análisis. Rev Colomb Anestesiol. 2014;42:136-7.
10. Beilin Y, Guinn NR, Bernstein HH, Zahn J, Hossain S, Bodian CA. Local anesthetics and mode of delivery: bupivacaine versus ropivacaine versus levobupivacaine. Anesth Analg. 2007;105:756-63.
11. Zapata-Sudo G, Trachez MM, Sudo RT, Nelson TE. Is comparative cardiotoxicity of S(-) and R(+) bupivacaine related to enantiomer-selective inhibition of L-type Ca2+ channels? Anesth Analg. 2001;92:496-501.
12. Comparative Obstetric Mobile Epidural Trial (COMET) Study Group, UK. Effect of low- dose mobile versus traditional epidural techniques on mode of delivery: a randomized controlled trial. Lancet. 2001;358:19-23.
13. Kee WDN, Ng FF, Khaw KS, Lee A, Gin T. Determination and comparison of graded dose-response curves for epidural bupivacaine and ropivacaine for analgesia in laboring nulliparous women. Anesthesiology. 2010;113:445-53.
14. Sultan P, Murphy C, Halpern S, Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis. Can J Anaesth. 2013;60:840-54.
15. Aguilar-Barojas S. Fórmulas para el cálculo de la muestra en investigaciones de salud. Salud en Tabasco. 2005;11:333-8.
16. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011;7:CD000331. Disponible en:
17. Shnider SM, Levinson G, Ralston D. Regional anesthesia for labor and deliver. In: Shnider SM, Levinson G, editors. Anesthesia for obstetrics. 3a ed. Baltimore: Williams and Wilkins; 1995. p. 135-53.
18. Chesnut DH, Laszewski LJ, Pollack K, Bates J, Manago NK, Choi W. Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanil during the second stage of labor. Anesthesiology. 1990;72:613-8.
19. Gomar C, Fernández C. Epidural analgesia-anesthesia in obstetrics. Eur J Anaesthesiol. 2000;17:542-58.
20. Howell CJ, Dean T, Lucking L, Dziedzic K, Jones PW, Johanson RB. Randomised study off long term outcome after epidural versus non-epidural during labour. Obstet Gynecol. 2003;101:195-8.
21. Loughnan BA, Carli F, Romney M, Dore CJ, Gordon H. Randomized controlled comparision of bupivacaine versus pethidine for analgesia in labour. Br J Anaesth. 2000;84:715-9.
22. Halpern S, Breen T, Campbell DC, Blanchard W. Epidural PCA fentanyl/bupivacaine vs IV PCA fentanyl: neonatal effects. Anesthesiology. 1999;90:A119.
23. Stienstra R, Jonker TA, Bourdrez P, Kuijpers JC, Van Kleef JW, Lundberg U. Ropivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labor: a double-blinded comparison. Anesth Analg. 1995;80:285-9.
24. Owen MD, D'Angelo R, Gerancher JC, Thompson JM, Foss ML, Babb JD, et al. 0.125% ropivacaine is similar to 0.125% bupivacaine for labor analgesia using patient-controlled epidural infusion. Anesth Analg. 1998;86:527-31.
25. Eddleston JM, Holland JJ, Griffin RP, Corbett A, Horsman EL, Reynolds F. A double-blind comparison of 0.25% ropivacaine and 0.25% bupivacaine for extradural analgesia in labour. Br J Anaesth. 1996;76:66-71.
26. Meister GC, D'Angelo R, Owen M, Nelson KE, Gaver R. A comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labour. Anesth Analg. 2000;90:632-7.
27. Lee BB, Ngan Kee WD, Ng FF, Lau TK, Wong ELY. Epidural infusions of ropivacaine and bupivacaine for labor analgesia: a randomized double-blind study of obstetric outcome. Anesth Analg. 2004;98:1145-52.
28. Polley LS, Columb MO, Naughton NN, Wagner DS, M. van de Ven CJ. Effect of epidural epinephrine on the minimum local analgesic concentration of epidural bupivacaine in labor. Anesthesiology. 2002;96:1123-8.
29. Scott DB, Lee A, Fagan D, Bowler GMR, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563-9.
30. Segado-Jiménez MI, Arias-Delgado J, Domínguez-Hervella F, Casas-García ML, López-Pérez A, Izquierdo-Gutiérrez C. Analgesia epidural obstétrica: fallos y complicaciones neurológicas de la técnica. Rev Soc Esp Dolor. 2011;18: 276-82.
31. McCrae AF, Jozwiak H, McClure JH. Comparison of ropivacaine and bupivacaine in extradural analgesia for relief of pain in labour. Br J Anaesth. 1995;74:261-5.
32. Cohen S, Yeh J, Riley E, Vogel T. Walking with labor epidural analgesia. Anesthesiology. 2000;92:387-92.
33. Collis RE, Harding SA, Morgan BM. Effect of maternal ambulation on labour with low-dose combined spinal epidural analgesia. Anaesthesia. 1999;54:535-9.
34. Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJM. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology. 1999;90:944-50.
35. Lacassie HJ, Columb MO. The relative motor blocking potencies of bupivacaine and levobupivacaine in labor. Anesth Analg. 2003;97:1509-13.
How to Cite
Rodríguez-Ramón R, Márquez-González H, Jiménez-Báez MV, Iparrea-Ramos IC. Analgesic efficacy of two concentrations of bupivacaine in women in labor: Randomized, controlled, triple blind clinical trial. Colomb. J. Anesthesiol. [Internet]. 2015Jul.1 [cited 2021Sep.27];43(3):179-85. Available from:


Download data is not yet available.
How to Cite
Rodríguez-Ramón R, Márquez-González H, Jiménez-Báez MV, Iparrea-Ramos IC. Analgesic efficacy of two concentrations of bupivacaine in women in labor: Randomized, controlled, triple blind clinical trial. Colomb. J. Anesthesiol. [Internet]. 2015Jul.1 [cited 2021Sep.27];43(3):179-85. Available from:

More on this topic