Epidural Ropivacaine with Dexmedetomidine versus Fentanyl for Labour Analgesia: Effect on Neonatal Apgar Score, Neonatal Adaptive Capacity Score and Cord Blood Gases – A Randomised Comparative Study

Background: Epidural fentanyl improves ropivacaine labour analgesia but causes opioid-related adverse effects; the neonatal effects of epidural dexmedetomidine are less well documented. Aims and Objective: To compare epidural ropivacaine with dexmedetomidine or fentanyl for labour analgesia, with emphasis on Apgar score, Neonatal Adaptive Capacity Score (NACS) and umbilical arterial blood gases. Materials and Methods: In this prospective randomised study (May 2025–April 2026), 100 parturients in active labour received epidural 0.1% ropivacaine with dexmedetomidine 0.5 µg/mL (Group RD, n=50) or fentanyl 2 µg/mL (Group RF, n=50). The primary outcome was the 1-minute Apgar score; all other outcomes were secondary. Pain scores were also analysed, post hoc, with adjustment for baseline Visual Analogue Scale (VAS) score. Results: Onset of analgesia was faster in Group RD (12.50±0.99 vs 15.36±1.35 min; p<0.001), ropivacaine consumption was lower (47.48±3.99 vs 55.59±5.73 mL; p<0.001) and fewer women needed rescue boluses (4% vs 76%; p<0.001). Baseline VAS was higher in Group RD; in a post hoc baseline-adjusted analysis, VAS remained lower in Group RD at 5, 10, 60, 90 and 120 minutes (overall adjusted difference −0.51, 95% CI −0.63 to −0.40). No significant differences were detected in the primary outcome, 1-minute Apgar score (7.94±0.24 vs 8.00±0.00; p=0.08), or in 5-minute Apgar score, NACS (p=0.06), cord pH (p=0.055) or base deficit; umbilical arterial pCO2 was lower in Group RD (49.10 vs 51.05 mmHg; p<0.001), a difference of uncertain clinical significance. Pruritus (0 vs 5) and nausea/vomiting (2 vs 9) were numerically, but not significantly, less frequent with dexmedetomidine. Conclusion: Dexmedetomidine provided faster labour analgesia with less ropivacaine than fentanyl. No significant neonatal differences were detected, but the study was not powered to establish neonatal safety.