Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 106796

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : UC01 - UC05 Full Version

Effectiveness of 0.125% Bupivacaine versus 0.125% Ropivacaine in Epidural Labour Analgesia- A Randomised Clinical Study

Published: December 1, 2022 | DOI:
K Udaya Bhaskar, MS Anusha, Jagannath, KC Arun, Jagadeesan, Mohan Koyee

1. Associate Professor, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India. 2. Assistant Professor, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India. 3. Associate Professor, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India. 4. Senior Resident, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India. 5. Professor, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India. 6. Professor and Head, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India.

Correspondence Address :
Dr. KC Arun,
Senior Resident, Department of Anaesthesiology, PES Institute of Medical Sciences Research, Kuppam-517425, Andhra Pradesh, India.


Introduction: Epidurally administered local anaesthetics provide most effective analgesia during labour process. Among the available local anaesthetics, bupivacaine and ropivacaine are the most commonly used drugs in concentrations ranging from 0.0625% to 0.125% and 0.08% to 0.125%, respectively. Both these drugs are weak bases, highly protein-bound, highly lipid soluble, and have a pKa of 8.1, low unionised fraction, thus, having a slightly longer time for onset of action but with a longer duration of action and have less transfer across the placenta. Hence, they are ideal drugs for use in labour analgesia.

Aim: To compare the effectiveness of programmed intermittent bolus of 0.125% bupivacaine vs 0.125% ropivacaine in low volumes in full term primigravidas for epidural labour analgesia.

Materials and Methods: This randomised clinical study was conducetd at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, between June 2020 and December 2021 among 80 full-term primi parturients requiring normal vaginal delivery. They were randomly divided into two groups of 40 each. Group B received 10 mL of 0.125% bupivacaine and group R received 10 mL of 0.125% ropivacaine as initial bolus dose. Repeat doses of 5 mL was given every 60 minutes or when the patient had Visual Analogue Score (VAS) score >4 with a maximum dose of 10 mL/hr with a 20 minute interval between two doses. Parameters assessed were onset, duration, level and quality of analgesia, motor blockade, number of epidural top ups, total volume of drug consumed, mode of delivery, duration of labour, APGAR score, haemodynamics, patient satisfaction and complications. Data was entered in Microsoft Excel 2010 version and analysed using Statistical Package for Social Sciences (SPSS) version 20.0.

Results: Both drugs were equally effective in terms of analgesia, maternal and foetal outcomes. Bupivacaine had a faster onset of action (7.075±0.916 min) compared to ropivacaine (8.225±0.891 min) (p-value=0.001). Ropivacaine had a shorter duration of action (43.1±2.30 min vs 47.9±4.16 min in group B) (p-value=0.0001), requiring more top-up doses (5.2±0.46 vs 4.77±0.61 in group B) (p-value=0.0007), and more total volume of drug (38.5±3.08 mL vs 35.5±4 mL in group B) (p-value=0.002). It also caused lesser motor blockade (Bromage score of 1 in 1 parturient vs 8 parturients in group B) (p-value=0.0129) and better overall maternal satisfaction score (excellent) in 30 parturients vs 25 parturients in group B. APGAR scores at 1 minute and 5 minutes were comparable between the two groups. Mean heart rates, mean blood pressures were also comparable between the two groups. There were no significant adverse effects in either groups.

Conclusion: By providing minimal motor blockade and adequate analgesia 0.125% ropivacaine allows parturients to go through the labour process with excellent maternal satisfaction and minimal adverse effects compared to 0.125% bupivacaine.


Maternal satisfaction, Motor blockade, Programmed intermittent epidural labour analgesia

Labour is an extremely painful process and is the main contributor to anxiety and stress. A painful uterine contraction increases sympathetic nervous system activation resulting in increased plasma catecholamines in mother affecting endocrine, respiratory, cardiovascular systems and uteroplacental circulation and thereby, affecting both mother and foetus (1),(2),(3).

The primary care provider’s responsibility is to titrate analgesic requirements based on circumstances like pain tolerability, anticipated duration of labour, and foetal condition. Epidural blockade is an effective method of providing analgesia during labour (4). With the emerging concept of minimal strength local anaesthetic dose and volumes, all present-day labour epidurals are given minimal strength local anaesthetic doses of 0.125% to 0.0625% also known as walking epidurals (5),(6). These low dose regimes limits motor blockade and do not affect the progress of labour and have minimal side-effects to mother and foetus (7). Bupivacaine in various strength is the most widely used local anaesthetic for epidural labour analgesia but is associated with motor blockade, decreased maternal bearing down efforts in the second stage of labour and increased instrumental deliveries. Ropivacaine is a homologue of bupivacaine, which causes less motor blockade and less cardiotoxicity and hence, a local anaesthetic of choice in labour analgesia (8).

Programmed intermittent bolus injections into the epidural space has been found to be more effective method for labour analgesia compared to other techniques, as there is significantly short second stage of labour, slightly lesser total anesthetic used, and higher maternal satisfaction (9),(10).

Hence, the present study was undertaken to study the effectiveness of bupivacaine and ropivacaine in low concentrations of 0.125% with low volumes of 5 mL top-up doses when used as programmed intermittent bolus injections for epidural labour analgesia without any adjuvants. The primary outcomes measured were onset of analgesia, duration of analgesia, VAS scores, degree of motor block and maternal satisfaction. The secondary outcomes measured were total volume of local anaesthetic used, number of top-ups used, haemodynamic variables, APGAR score at 1st and 5th minute and side-effects.

Material and Methods

The randomised clinical study was undertaken at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India. between June 2020 and December 2021. The Institutional Human Ethical Committee had approved the study (PESIMSR/IHEC/31/2019).

Sample size calculation: A sample size of 37 parturients per group was calculated using the formula:


(Z1-α/2=1.96,Z1-β/2=0.84,α=0.05, β=0.80, σ=3.46, δ=2.23) and was rounded of to 40 parturients in each group (11).

Inclusion criteria: All primigravida parturients of ASA physical status I and II with singleton uncomplicated pregnancy with vertex presentation in labour, with a cervical dilatation of 3-4 cm were included in the study.

Exclusion criteria: All patients with allergy to study drugs, unwilling parturients, deranged coagulation profile and infection, at the site of epidural catheter insertion were excluded from the study.

The Consolidated Standards of Reporting Trials (CONSORT) flowchart is as shown in (Table/Fig 1). All the parturients who were enrolled received a successful epidural analgesia, there were no dropouts from the study. The parturients were randomly allotted to either group B or group R, using blinded opaque envelopes sorted by computer-generated random allocation.

• Group B: Patients were given 10 mL of 0.125% Bupivacaine as bolus.
• Group R: Patients were given 10 mL of 0.125% Ropivacaine as bolus.

Study Procedure

A detailed preanaesthetic evaluation was done including demographic data, parity, gestational age and the condition of the membrane. After explaining the procedure and obtaining informed written consent, 18 G intravenous cannula was secured and preloaded with 300 mL of ringer’s lactate, standard monitors applied and baseline values were recorded. Epidural space was identified with 18 G Tuohy’s needle in L3-4 or L4-5 interspace with loss of resistance to air technique and a 18 G epidural catheter threaded and fixed with approximately 3 cms of the catheter inside the epidural space. An epidural test-dose of 2 mL 2% lignocaine with 1:2,00,000 adrenaline administered to rule out intravascular or intrathecal injection. After confirming the position of the epidural catheter, parturients in group B were given 10 mL of 0.125% bupivacaine as bolus and those in group R were given 10 mL of 0.125% ropivacaine as bolus. Analgesia was maintained by intermittent bolus injections of 5 mL every 60 minutes. Parturients, who experienced inadequate analgesia {Visual Analogue Score (VAS) >4} during the labour process were supplemented with an additional 5 l of study drug up to a maximum of 10 mL/h until the delivery of the baby. Supplementation was given only after 20 minutes of the previous dose. The anaesthesiologist performing the procedure and recording the study parameters were blinded to the study. All the essential drugs and equipment were kept ready near the patients throughout the labour period.

The onset and duration of analgesia, motor block using Bromage scale, pain scores using VAS score on a scale of 0-10, total volume of drug used, intrapartum haemodynamics, mode of delivery, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score at 1 and 5 minutes, maternal satisfaction on a 4-point scale as excellent, good, fair, or poor on a verbal numerical score from 0 to 10 were noted (12):

Score 8-10 was taken as excellent,
Score 5-7 as good,
Score 2-4 as fair,
Score <2 as poor
Side-effects, if any, were monitored continuously after administering the study drug.

All the above parameters were recorded at 0, 5, 15, 30 min and every 30 min, and after each top-up every five minute for 15 min, untill delivery.

Statistical Analysis

Data was entered in Microsoft Excel 2010 version and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. For descriptive analysis, the categorical variables were analysed by calculating frequency and percentages, continuous variables were analysed by calculating mean and standard deviation. For inferential analysis, the numerical data were analysed with t-test, mean values of both the groups, were compared with unpaired Student’s t-test. Chi-square test analysed categorical data and two attributes like mode of delivery, maternal satisfaction score. A p-value <0.05 was considered as statistically significant.


There was no statistical difference in demographic data, gestational age and cervical dilatation between the two groups at the time of enrollment (Table/Fig 2).

There was a faster onset of analgesia in group B. Mean duration of analgesia after each dose, was significantly longer in group B compared to group R, so number of top-up doses required and total volume of study drug used was significantly lesser in group B. Maximum Bromage score achieved was 1 in both groups but more number of parturients in group B were 8 (20%) achieved this score compared to 1 (2.5%) parturient in group R. Mean duration of second stage of labour significantly prolonged in group B. One patient in group B had hypotension compared to none in group R, two patients in group B had nausea compared to one patient in group R both the incidences were statistically insignificant. There was no statistically significant difference in level of block, APGAR score, mode of delivery, haemodynamic parameters and complications (Table/Fig 3) between two groups. Though more number of parturients in group R had better maternal satisfaction score, this was statistically not significant (Table/Fig 3).

There was no significant difference in the VAS scores for the entire duration of labour between the two groups (Table/Fig 4).


Labour pain is the most severe form of pain that is experienced and it varies at different stages of labour. Pain during the first stage is due to dilatation, stretching, tearing of the lower uterine segment and cervix, mediated through the visceral fibers to T10-L1 segments, hence the pain is vague (13). In the second stage of labour, pain intensity increases as the foetus passes through the birth canal dilating, stretching and tearing the tissues along the birth canal and is mediated through the somatic nerves to the lumbosacral segments, hence, the intensity is more (13).

Adequate analgesia can be produced by blocking these nerve segments through the epidural route. Bupivacaine and ropivacaine are the most commonly used drugs to provide labour analgesia in concentration ranging from 0.08%-0.2%. Bupivacaine is an amide which is composed of a racemic mixture of R and S isomers in equal proportions. It acts by binding to sodium channels in its inactivated state, block the movement of sodium ions across the nerve membrane, thus, prevents repolarisation of nerve membrane and nerve conduction. Bupivacaine is highly protein bound, lipophilic drug with pKa of 8.1, at physiologic pH exists in ionised form with a foetal-maternal concentration of 0.2-0.4 (14),(15). It provides differential blockade of nerve fibers based on the drug concentration, size of nerve fiber and rate of nerve depolarisation. The smaller myelinated nerve fibres are more sensitive than larger and non myelinated fibres, hence, it produce analgesia by blocking the A γ and A δ fibres even at low concentration. Ropivacaine is an homologue of bupivacaine has similar properties, but as it is formulated as a single levorotatory isomer, it is less cardiotoxic, with lesser motor blocking property than bupivacaine at equal concentrations with foetal maternal concentration ratio of 0.2 (14),(15).

The present study compared effectiveness of bupivacaine vs ropivacaine in low concentration (0.125%) as intermittent bolus doses in low volume (5 mL) and found that though ropivacaine had a slower onset and shorter duration of analgesia, it was associated with less number of patients having motor block, hence, shorter second stage of labour compared to bupivacaine and hence, it had a better maternal satisfaction score.

The slower time for onset of analgesia with ropivacaine was due to lower lipid solubility, which results in longer time taken for the drug to enter and block nerve transmission. These results correlated with study by Finegold H et al., who compared 0.25% bupivacaine followed by 0.125% bupivacaine with fentanyl 2 mcg/mL and 0.2% ropivacaine followed by 0.1% ropivacaine with fentanyl 2 mcg/mL and found the onset of analgesia in bupivacaine was faster compared to ropivacaine (16). Shenvi SS and Jaiswal AV, compared 15 mL of 0.1% bupivacaine vs 0.1% ropivacaine with 2 mcg/mL fentanyl and found a faster onset time for bupivacaine group (11).

In the present study, the sensory level in most of the parturients was T8 in both groups. Kumar GS et al., did a randomised comparison of bupivacaine 0.125% vs ropivacaine 0.125% with fentanyl 2 mcg/mL. They observed that the upper sensory level was T10 in all the groups (17). The results of the present study were comparable to others where the sensory blockade achieved was T8 in most of the parturients (5),(18),(19). These results suggest that, both the study drugs in low concentrations produced adequate sensory blockade irrespective of the additives used.

The mean VAS scores before the study drug injection and at different time intervals, after study drug injection between groups was comparable and statistically insignificant. Similar findings were reported by Kulkarni K and Patil R, who compared bupivacaine 0.125%, ropivacaine 0.125% with the addition of fentanyl 2 mcg/mL and observed no difference in VAS score between both the groups (20). Similar results were also reported by few others (11),(17),(19),(21). The time to achieve a VAS score of 2 in the two groups in the study by Kulkarni K and Patil R, was 10 minutes and a score of 1 was achieved at 15 minutes in both the groups (20). In the present study, a VAS score of 4 was achieved at five minutes and a score of 0.42 was achieved by 15 minutes in both the groups. These results suggest that, both study drugs produce satisfactory analgesia, when used without any adjuvants.

The mean duration of analgesia was significantly longer in bupivacaine group and hence, required lesser top-up doses. But analgesia remained excellent in both groups. There were episodes of breakthrough pain at 180 min and 210 min in ropivacaine group, but VAS scores were <4. This is probably because of ultralow concentrations of the local anaesthetic solutions used at regular intervals. A few contributory factors include increased intensity of pain towards the second stage of labour, misinterpretation of discomfort due to head on perineum as pain. This findings had no clinical significance because VAS score were within 4, and maternal satisfaction remained good. Duration of analgesia and VAS scores were comparable to study done by Kumar GS et al., and Kulkarni K and Patil R (17),(20).

Motor blockade mainly depends on the potency, concentration, and volume of the local anaesthetic solution used. Among 80 parturients, 8 (20%) in bupivacaine group and 1 (2.5%) in ropivacaine group had a Bromage score of 1. Remaining all the parturients in both groups had Bromage score of zero. This higher Bromage score in group B probably had effect on prolonging the duration of second stage of labour. These results were comparable to the study conducted by Fernández-Guisasola J et al., wherein the second stage of labour duration was 57±47 min in group B (0.0625% bupivacaine) and 47±38 min in group R (0.1% ropivacaine) (19). The present study results also matched with study by Kumar GS et al., who found a significant less motor blockage with ropivacaine with fentanyl (17).

The higher Bromage score did not affect the mode of delivery, as equal number of parturients in both groups had normal vaginal delivery. Though more number of parturients in ropivacaine group had an excellent maternal satisfaction scores, there was no statistically significant difference in overall quality of analgesia between the two groups. This correlated with the study by Steinstra R et al., (22). The overall duration of labour was comparable between the two groups which correlates with studies by Kumar GS et al., and Wang L et al., who compared both, ropivacaine and bupivacaine in equal concentrations (17),(23). The results of the present study showed that irrespective of the additives used both drugs were effective with respect to the onset of analgesia, duration of analgesia, VAS scores, and the degree and incidence of motor block.

Total volume of drug used was 38.5 mL and 35.5 mL of ropivacaine and bupivacaine, respectively, which was statistically significantly but relatively less than in study by Meister GC et al., (21). Relatively better APGAR scores at one minute and five minute were observed in group R compared to group B but was not statistically significant. This correlated with study by Gaiser RR et al., wherein APGAR >7 was 100% in Group R vs 97% in Group B at five minute (24). Trends of mean of heart rate, systolic, diastolic and mean arterial pressure for the entire duration of labour, recorded in two groups did not show any clinical or statistical difference. These haemodynamic parameters correlated with study by Wang L et al., (23).

The most common side-effect in both the groups was nausea and/or vomiting, with an incidence of 5% in group B and 21% in group R, and it was treated with injection ondensetron 5 mg intravenous.


The study was conducted in ASA I and II primigravidas with uncomplicated pregnancies. Moreover, results can not be generalised to multigravida, parturients with co-existing diseases and parturients with complicated pregnancies like breech presentation, twin pregnancy, preterm delivery.


To conclude, both bupivacaine and ropivacaine in concentrations of 0.125% in low volumes given as intermittent bolus doses epidurally without any adjuvants produced satisfactory labour analgesia, without compromising maternal safety or foetal outcome. Ropivacaine produced lesser incidences of motor blockade compared to bupivacaine and hence, better maternal satisfaction, but had a shorter duration of action requiring more number of top-up doses and greater total volume of drug used, but this had no effect on the outcome of labour or foetal well-being.


Chestnut’s Obstetric Anesthesia: Principles and Practice; 6th edition. 2019:296-98.
Hawkins JL. Epidural analgesia for labour and delivery. N Engl J Med. 2010;362:1503-10. [crossref] [PubMed]
Hughes SC, Levinson G, Rosen MA. Regional Anesthesia for Labour and Delivery. Schnider and Levinson’s Anesthesia for Obstetrics; 4th edition. Philadelphia: Lippincott Williams & Wilkins. 2002;123-28.
Pandya ST. Labour analgesia: Recent advances. Ind J Anaesth. 2010;54(5):400-08. [crossref] [PubMed]
Atienzar MC, Palanca JM, Torres F, Borras R, Gil S, EsteveI. A randamized comparison of levoBupivacaine, Bupivacaine and ropivacaine with fentanyl, for labour analgesia. IntJ Obstet Anesth. 2008;17:106-11 [crossref] [PubMed]
McClellan KJ, Faulds D. Ropivacaine. Drugs. 2000;60:1065-93. [crossref] [PubMed]
Katz JA, Bridenbaugh PO, Knarr DC, Helton SH, Denson DD. Pharmacodynamics and pharmacokinetics of epidural ropivacaine in humans. Anesth Analg. 1990;70(1):16-21. [crossref] [PubMed]
Delgado C, Ciliberto C, Bollag L, Sedensky M, Landau R. Continuous epidural infusion versus programmed intermittent epidural bolus for labour analgesia: Optimal configuration of parameters to reduce physician-administered top-ups. Curr Med Res Opin. 2018;34(4):649-56. [crossref] [PubMed]
Lim Y, Sia ATH, Ocampo C. Automated regular epidural analgesia: A comparision with continuous infusion. Int J Obstet Anesth. 2005;14(4):305-09. [crossref] [PubMed]
Wong CA, Ratliff JT, Sullivan JT, Scavone BM, Toledo P, McCarthy RJ, et al. A randomised comparison of programmed intermittent epidural bolus with continuous epidural infusion for labour analgesia. Anesthesia & Analgesia. 2006;102(3):904-09. [crossref] [PubMed]
Shenvi SS, Jaiswal AV. A comparative study on the effects of 0.1% bupivacaine and 0.15% ropivacaine for epidural analgesia during labour. International Journal of Contemporary Medical Research. 2018;5(12):L1-L6. [crossref]
Clivatti J, Siddiqui N, Goel A, Shaw MRN, Crisan IRN, Carvalho JCA, et al. Quality of labour neuraxial analgesia and maternal satisfaction at a tertiary care teaching hospital: A prospective observational study. Can J Anesth. 2013;60:787-95. [crossref] [PubMed]
Chestnut’s Obstetric Anesthesia: Principles and Practice; 6th edition. 2019:425-26.
Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian Journal of Anaesthesia. 2011;55(2):104-10. [crossref] [PubMed]
Chestnut’s Obstetric Anesthesia: Principles and Practice; 6th edition. 2019:272.
Finegold H, Mandell G, Ramanathan S. Comparrison of ropivacaine 0.1%-Fentanyl and bupivacaine 0.125%-Fentanyl infusions for labour epidural analgesia. Can J Anesth. 2000;47:740-45. [crossref] [PubMed]
Kumar GS, Rao BS, Kumar UM. A comparative study of equi-concentration of Bupivacaine-Fentanyl and Ropivacaine-Fentanyl for epidural labour analgesia. Int J Sci Stud. 2018;6(5):112-20.
Owen MD, Thomas JA, Smith T, Harris LC, D’Angelo R. Ropivacaine 0.075% and Bupivacaine 0.075% with fentanyl 2 μg/mL are equivalent for labour epidural analgesia. Anesth Analg. 2002;94(1):179-83. [crossref]
Fernández-Guisasola J, Serrano ML, Cobo B, Munoz L, Plaza A, Trigo C, et al. A comparison of 0.0625% bupivacaine with fentanyland 0.1% ropivacaine with fentanyl for continuous epidural labour analgesia. Anesth Analg. 2001;92:1261-65. [crossref] [PubMed]
Kulkarni K, Patil R. Comparison of ropivacaine-fentanyl with bupivacaine-fentanyl for labour epidural analgesia. The Open Anesthesiology Journal. 2020;14(1):108-14. [crossref]
Meister GC, D’Angelo R, Owen M, Nelson KE, Gaver RA. Comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labour. Anesthesia and Analgesia. 2000;90(3):632-37. [crossref] [PubMed]
Stienstra R, Jonker TA, Bourdrez P, Kuijpers JC, van Kleef JW, Lundberg U, et al. Ropivacaine 0.25% versus bupivacaine 0.25% for continuous epidural analgesia in labour: A double blind comparison. Anesth Analg. 1995;80:285-89. [crossref] [PubMed]
Wang L, Chang X, Liu X, Xiao-xia H, Tang B. Comparison of bupivacaine, ropivacaine and levoBupivacaine with sufentanil for patient-controlled epidural analgesia during labour: A randomised clinical trial. Chin Med J. 2010;123(2):178.
Gaiser RR, Venkateswaren P, Cheek TG, Persiley E, Buxbaum J, Hedge J, et al. Comparison of 0.25% ropivacaine and Bupivacaine for epidural analgesia for labour and vaginal delivery. Journal of Clinical Anesthesia. 1997;9(7):564-68. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/60859.17224

Date of Submission: Oct 17, 2022
Date of Peer Review: Nov 07, 2022
Date of Acceptance: Nov 19, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Oct 18, 2022
• Manual Googling: Nov 16, 2022
• iThenticate Software: Nov 18, 2022 (12%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)