Comparison of local anesthesia combinations for labor pain relief

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Created On: 20/08/2025

Epidural anesthesia remains the most widely used method for yielding pain relief during labor, often administered in combination with various local anesthetics.

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Key take away

Ropivacaine combined with dexmedetomidine and sufentanil provides the most effective and rapid pain relief during labor with a favorable safety profile.

Background

Epidural anesthesia remains the most widely used method for yielding pain relief during labor, often administered in combination with various local anesthetics. However, the analgesic effectiveness and safety of different anesthetic regimens vary considerably. Hence, this study aimed to evaluate and compare the efficacy and adverse effects of multiple local anesthetic combinations for labor analgesia via a network meta-analysis approach.

Method

An extensive search of PubMed, Embase, Web of Science, and the Cochrane Library was executed. Eligible studies involving women (aged 18 to 35 years) undergoing epidural anesthesia for pain-free labor were included.

Result

In total, 59 studies encompassing 6,972 volunteers were included. The combination of ropivacaine, dexmedetomidine, and sufentanil illustrated the most rapid and effective reduction in pain, as measured by visual analog scale (VAS) scores 30 minutes after block administration, outperforming most other regimens. Ropivacaine + dexmedetomidine was linked with a longer duration of labor pain.

In terms of side effect profiles, combinations such as bupivacaine with pethidine, bupivacaine with dexmedetomidine, fentanyl alone, and bupivacaine with diamorphine were related to the lowest rates of nausea, vomiting, hypotension, and pruritus. Notably, bupivacaine + dexmedetomidine, ropivacaine + dexmedetomidine, and ropivacaine + dexmedetomidine + sufentanil regimens exhibited both strong analgesic efficacy and favorable safety outcomes.

Conclusion

The regimen combining ropivacaine, dexmedetomidine, and sufentanil appears to be the most effective option for labor analgesia. However, due to the limited number of studies evaluating certain anesthetic combinations, further well-designed, large-scale trials are needed to validate these findings.