• Mahmoud Shokry, Essam M Manaa, Randa Ali Shoukry, Mohamed Hossam Shokeir, Ghada O Elsedfy, and Abd El-Salam Abd El-Aziz.
• Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt. mshromih@yahoo.com
• Acta Obstet Gynecol Scand. 2010 Jul 1;89(7):909-15.

ObjectivesTo investigate whether intrapartum epidural analgesics (bupivacaine or ropivacaine) have an influence (safety and efficacy) on mothers, fetuses, or newborns at high altitudes (2,200 m above the sea level).DesignProspective randomized trial.SettingA tertiary referral hospital in Aseer region, Saudi Arabia.PopulationEighty parturient women with normal full term pregnancy (37-40 weeks) were randomly allocated to a group receiving epidural bupivacaine 0.125% and the other receiving ropivacaine 0.2%, with fentanyl 100 microg given to both groups.MethodsIntra- and postpartum clinical management of the pregnant women and newborns and fetal Doppler assessments were performed.Main Outcome MeasuresSeverity of pain, onset and duration of analgesia, and occurrence of motor blockade were primary outcomes. Progress of labor, need for oxytocin augmentation, mode of delivery, and neonatal condition were secondary outcomes.ResultsDemographic, labor characteristics, and neonatal outcomes of the two groups were comparable. The onset of analgesia was relatively more rapid for ropivacaine group (p = 0.067). Duration of analgesia after the first bolus dose was longer and the need for supplemental epidural analgesic doses was lesser in the bupivacaine group (p = 0.041 and 0.045, respectively). In both groups, the fetal umbilical and middle cerebral artery pulsatility indices showed significant change when compared to the baseline of the same group.ConclusionAt high altitudes, no major advantage was found for epidural ropivacaine over bupivacaine in addition to fentanyl for labor analgesia and no harmful effects of the medications were found on mothers, fetuses, or newborns.

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