ABSTRACT
Introduction: Labour analgesia techniques is the mostwidely practised procedures of pain management performedby an anaesthesiologist and are requested by the obstetriciancolleagues as well as the parturient mothers. Presently,Combined Spinal Epidural (CSE) is the most popular andeffective technique of Labour Analgesia to render the motherpain free. This technique has two parts. Our study is primarilyconcerned with the first part of CSE for the comparison ofdrugs. The aim of the study was to compare the efficacybetween a small and fixed doses Fentanyl (25μgm) andHyperbaric 0.5% Bupivacaine (2.5mg) as the initial step ofCSE technique for labour analgesia.Material and methods: This double blind study aims tocompare the efficacy between a intrathecal fixed dose oflipophilic opioid i.e, Fentanyl (25μgm) and a fixed dose oflocal anaesthetic hyperbaric 0.5% Bupivacaine ( 2.5mg) as theinitial step to establish labour analgesia . 60 parturient willbe divided into two group. Group I will receive intrathecalFentanyl and Group II will receive intrathecal Bupivacaine.Onset, quality and quantity of pain relief achieved followingintrathecal injection of drugs will be taken into account whereasincidence of side-effects like motor paralysis, hypotension,pruritus, foetal bradycardia & respiratory depression willbe noted and compared. This will indicate which drug willbe more preferable as a sole drug for the initial intrathecalcomponent of CSE technique for labour analgesia.Results: The shortest time of onset of analgesia in group Iwas 60sec and in group II was 40sec which was statisticallysignificant (p<0.05). The average duration to reach maximumanalgesia in Group I was 5.93 ± 1.68 min and in Group IIwas 5.30 ± 1.31 min.Whereas the duration of analgesia wasfound varying widely. It was 54±15.16 minutes in Group Iwhereas 73.5±14.74 minutes in Group II. The duration rangedfrom 25 minutes to 80 minutes in Group I and 35 minutesto 100 minutes in Group II. This difference was statisticallysignificant (p=0.000005).The significant side effect noted waspruritus (56.67%) in Group I and motor paralysis (80%) andhypotension (6.67%) in Group II.Conclusion: A small dose of Fentanyl is preferable to asimilar small dose of Bupivacaine for the initial intrathecaladministration as a part of Combined Spinal Epidurallabour analgesia technique as muscle weakness prevents themother from taking active part in second stage of labour andhypotension is non desirable.