Comparative efficacy and safety of local anesthesia combinations for labor pain relief: a network meta-analysis.

Summary

Across 59 RCTs (n=6,972), ropivacaine+dexmedetomidine+sufentanil provided the fastest and most effective early analgesia (VAS at 30 min) among epidural regimens. Some bupivacaine-based combinations showed the lowest rates of nausea, vomiting, hypotension, and pruritus. Overall, dexmedetomidine-containing regimens (with or without sufentanil) demonstrated strong efficacy with acceptable safety.

Key Findings

• Ropivacaine+dexmedetomidine+sufentanil achieved the best and fastest reduction in VAS at 30 minutes after block among compared regimens.
• Ropivacaine+dexmedetomidine had the longest duration of labor pain (as reported), indicating differences in temporal analgesic profiles.
• Bupivacaine+pethidine, bupivacaine+dexmedetomidine, fentanyl alone, and bupivacaine+diamorphine showed the lowest rates of nausea, vomiting, hypotension, and pruritus.

Clinical Implications

Consider ropivacaine+dexmedetomidine+sufentanil for rapid early analgesia, while tailoring choices to maternal hemodynamics, institutional protocols, and fetal safety. Centers should evaluate feasibility and monitor for alpha‑2 agonist effects when adopting dexmedetomidine-containing regimens.

Limitations

• Heterogeneity in dosing, infusion strategies, and outcomes across trials; some regimens supported by few studies
• Obstetric and neonatal outcomes beyond analgesia (e.g., labor duration, fetal heart effects) variably reported

Future Directions

High-quality multicenter RCTs directly comparing top-ranked regimens with standardized dosing and comprehensive maternal–fetal outcomes are needed to confirm rankings and refine safety profiles.