Epidural ropivacaine versus bupivacaine for cesarean sections: a system review and meta-analysis

Figures & data

Figure 1. Funnel plot of included studies. RR: risk ratio.

Figure 2. PRISMA flow diagram of eight RCTs.

Figure 3. Summary of risk of bias.

Table 1. Baseline demographics of included studies.

Author	Year	Sample (R/B)	ASA (R/B)	Age (R/B, years)	Height (R/B, cm)	Weight (R/B, kg)	Intervention		Blockade level for surgery
							R	B
GRIFFIN [12]	1995	37/35	I/Π	32 (20–43)/32 (23–42)	164/162	79/79	0.5% R 23.7 ml	0.5% B 23.1 ml	T6 pinprick
Sanjay [13]	1995	31/29	U	31.5 ± 0.92/33.0 ± 0.86	160 ± 0.56/161 ± 0.47	75.2 ± 5.37/73.0 ± 4.62	0.5% R 30 ml	0.5% B 30 ml	T4 pinprick
Edward [14]	1998	30/31	I/Π	31 ± 6/32 ± 4	161 ± 6/161 ± 6	76 ± 11/76 ± 9	0.5% R 22 ml	0.5% B 21.3 ml	T6 pinch
Bjørnestad [15]	1999	83/39	I/Π	32 ± 4.8/33 ± 4.0	167 ± 6.5/165 ± 5.7	78 ± 12/77 ± 10	0.75% R 20 ml	0.5% B 20 ml	T6 pinprick
Carlos [16]	2003	30/30	I	26.43 ± 2.12/26.47 ± 2.08	162 ± 2/161 ± 2	74.53 ± 4.12/72.10 ± 4.54	0.75% R 23 ml + fentanyl (2 ml: 100 µg)	(0.5% B + 1:200,000 epinephrine)23ml + fentanyl(2 ml: 100 µg)	T8 clamping skin
Sandra [17]	2004	31/29	I/Π	31 ± 3.8/31 ± 5.4	167 ± 0.1/166 ± 0.1	84 ± 21.3/82 ± 14.5	0.75% R 22 ± 3.2 ml	0.5% B 23 ± 4.7 ml	T6 pinprick
Christelis [18]	2005	31/36	U	U	U	U	0.75% R 20 ml	0.5% B 20 ml + fentanyl(2 ml: 100 µg)	T4 cold
Hafez [19]	2008	16/14	U	U	U	U	0.5% R 30 ml	0.5% B 30 ml	T6–T4 pinprick

Note: R: Ropivacaine; B: bupivacaine; U: unknow; T: thoracic.

Table 2. Summary of evidence for epidural ropivacaine versus bupivacaine for cesarean sections.

Outcomes	Women (trails)	Relative effect (95%Cl)	Results	Certainty (GRADE)	Comments
Success rate	512(7)	1.04(0.97,1.12)	NSD	⨁⨁◯◯ low	The outcome was objective to parturients and outcome assessors
Maternal hypotension	502(7)	1.02(0.88,1.18)	NSD	⨁⨁◯◯ low	The outcome was objective to parturients and outcome assessors
Maternal bradycardia	442(6)	1.11(0.79,1.57)	NSD	⨁⨁◯◯ low	The outcome was objective to parturients and outcome assessors
Maternal shivering	181(3)	1.51(0.71,3.23)	NSD	⨁⨁⨁◯ moderate	The outcome was objective to parturients and outcome assessors
Neonatal 1-min Apgar score ≥7	410(7)	0.98(0.94,1.02)	NSD	⨁◯◯◯ very low	The outcome was subjective to outcome assessors
Neonatal 5-min Apgar score ≥7	410(7)	1.00(0.97,1.02)	NSD	⨁◯◯◯ very low	The outcome was subjective to outcome assessors
Neonatal umbilical artery pH	186(3)	0.01(−0.00,0.02)	NSD	⨁⨁◯◯ low	The outcome was objective to parturients and outcome assessors
Maternal nausea	133(2)	0.49(0.28, 0.83)	0.5% ropivacaine was lower than 0.5% bupivacaine	⨁⨁◯◯ low	The outcome was subjective to parturients
Onset time of sensory block	247(3)	−0.43(−0.70, 0.17)	0.75% ropivacain was faster than 0.5% bupivacaine	⨁⨁◯◯ low	The outcome was subjective to outcome assessors

Note: CI: credible interval; NSD: no significant difference.

Table 3. Summary results of subgroup analysis.

Outcome	Studies	Sample size	Effect size	95%CI	p Value
0.75% ropivacaine vs 0.5% bupivacaine
Success rate of epidural block	4	309	RR 1.10	1.00 to 1.22	.05
Onset time of surgical block	3	247	SMD −0.43	−0.70 to 0.17	.001
Maternal hypotension	4	309	RR 1.09	0.82 to 1.45	.55
Maternal bradycardia	4	309	RR 1.03	0.74 to 1.44	.85
Maternal shivering	2	120	RR 1.44	0.65 to 3.20	.37
Maternal nausea	2	120	RR 1.14	0.56 to 2.35	.72
1-min neonatal Apgar scores	3	187	RR 0.98	0.91 to 1.05	.50
min neonatal Apgar scores	3	187	RR 0.99	0.95 to 1.03	.63
Neonatal umbilical artery pH	3	186	MD 0.01	−0.00 to 0.02	.11
0.5% ropivacaine vs 0.5% bupivacaine
Success rate of epidural block	3	193	RR 0.95	0.85 to 1.06	.36
Onset time of surgical block	2	121	SMD −0.34	−0.70 to 0.02	.07
Maternal hypotension	3	193	RR 0.98	0.84 to 1.13	.75
Maternal bradycardia	2	133	RR 2.30	0.34 to 5.44	.39
Maternal shivering	1	61	RR 2.07	0.20 to 1.62	.54
Maternal nausea	2	133	RR 0.49	0.28 to 0.83	.008
1-min neonatal Apgar scores	4	223	RR 0.98	0.93 to 1.03	.48
5-min neonatal Apgar scores	4	223	RR 1.00	0.97 to 1.03	1.00

Note: Bold values mean statistically significant results. CI: credible interval; RR: risk ratio; SMD: standardized mean difference; MD: mean difference.

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Data availability statement

The data generated for this study are available from the corresponding authors upon reasonable request.