When a Ropivacaine 0.2% Labor Epidural Won't Cut It

Near Denali National Park - photo by JoAnn Sturman

by Scott Sturman, M.D.

A laboring patient is enjoying excellent pain relief due to a continuous epidural infusing Ropivacaine 0.2% @ 12 cc/hr.  At 8 cm she begins to complain of symmetric and severe lower uterine pain with contractions.  On exam the sensory level is T6 bilaterally determined by pin prick, and the legs are numb.

Removing fentanyl from continuous epidural infusions has administrative advantages, but that's about it.  Patients are more apt to complain of pain during the active phase of the first stage of labor despite high sensory levels.  In these cases a fentanyl 100ug epidural bolus works wonders.  The onset is nearly immediate, and the benefit last 3-4 hours without having to use stronger local anesthetic boluses which may push the block level too high or interfere with the second stage of labor.