Study designs of evaluations included in the review
Only RCTs were eligible for inclusion in the review.
Specific interventions included in the review
Studies that compared epidural ropivacaine with bupivacaine for labour analgesia were eligible for inclusion. The additional administration of opioids was possible, but trials that used adjuvant medication (e.g. clonidine or fentanyl) in only one group were excluded. Studies that determined the effective dose by varying doses during treatment were also excluded.
Participants included in the review
Studies of women in labour using epidural pain relief were eligible for inclusion. Some of the included studies only provided data from nulliparous patients.
Outcomes assessed in the review
The primary outcome assessed in the review was the incidence of spontaneous vaginal delivery. The secondary outcomes were further obstetric, analgesia-related and neonatal data.
The obstetric outcomes included the total length of labour, the length of the second stage of labour, the incidence of forceps delivery and Caesarean delivery.
The analgesic outcomes included the onset and duration of analgesia, the number of excellent analgesia, the incidence of ambulation, the need for bladder catheterisation, hypotension, nausea or vomiting, the incidence of no motor block or full motor block, the duration of block, and the incidence of inadequate analgesia and block failure.
The neonatal outcomes were the incidence of an Apgar score of less than 7 at one minute and five minutes, an umbilical artery pH of less than 7.2 and the mean umbilical cord pH.
How were decisions on the relevance of primary studies made?
At least two reviewers independently assessed the eligibility of the studies.