Comparison of analgesic efficacy of intramuscular tramadol and pethidine in labour

Background: Labour pain is among the most severe pain experienced by women. It is unpleasant and distressing to the parturient. The objective of the study was to evaluate and compare the analgesic efficacy and adverse effects of intramuscular tramadol and pethidine in labour. Methods: The prospective study conducted in SDM College of Medical Sciences and Hospital, Department of OBG, from December 2013 to November 2014. The study was a study of the parturients admitted in the labour theatre. Written and informed consent was taken from all the patients enrolled in the study. One hundred parturient at term in active labour were randomly assigned to one of the two groups to receive intramuscularly either tramadol 100 mg or pethidine 75 mg. Results: Results were comparable in terms of maternal age, maternal weight and neonatal weight. Proportion of cases with satisfactory to good pain relief was 74% in the tramadol group and 78% in the pethidine group. Nausea and/or vomiting (12% versus 8%), fatigue (6% versus 4%) and drowsiness (8% versus 4%) were significantly high in the pethidine group than the tramadol group(p<0.05). The drugs used did not appear to influence the mode of delivery. Proportion of cases with non-reassuring foetal heart rate was high in the pethidine group. Meconium stained liquor was equally seen in both the groups and there were no incidence of neonatal respiratory depression in any of the groups.Conclusion: Tramadol is an equally effective labour analgesic as pethidine with less maternal and perinatal side effects.

Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia

Background: Toxonomy committee of International Association defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. The present study was conducted to evaluate the effect of a combination of low dose ropivacaine with fentanyl and tramadol in epidural labour analgesia.Methods: This prospective randomized double blinded clinical study was conducted in 100 patients in labour after ethical committee approval. Inclusion criteria was patients who had ASA I and ASA II (American society of anesthesiologists physical status classification system), age above 18 years, height more than 150 cm, weight less than 110 kg, either primigravidae or gravid 2. Patients were allocated into two groups Group F (ropivacaine with fentanyl) and group T (ropivacaine with tramadol) by computer generated randomisation technique.Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 22.54±2.5, mean age in group T (ropivacaine with tramadol) was 22.86±2.17, and weight in group F was 56.68±2.75 and group T was 56.58±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (P>0.05). More side effects were seen in group F.Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

Comparative Study of 0.2% Ropivacaine & 0.2% Ropivacaine with 0.5 mcg/mL Dexmedetomidine in Epidural Labour Analgesia.

Labour analgesia is the emerging technique in obstetric anaesthesia. There are various ways to provide painless labour to a mother. The best technique is epidural analgesia and providing a mother with good analgesia without a motor block is best done by ropivacaine and analgesia can be prolonged with addition of adjuvants. We wanted to compare efficacy, safety, quality of analgesia, total drug requirement, effect on the course and duration of labour, neonatal outcome, maternal satisfaction and adverse events if any, of ropivacaine 0.2% + 0.5 mcg/mL of dexmedetomidine with that of 0.2% of ropivacaine alone, for epidural labour analgesia.METHODS60 patients were divided in to 2 groups of 30 each RS and RD. RD received 8 mL of ropivacaine with 0.5 mcg/mL of dexmedetomidine while RS group received ropivacaine 8 mL with normal saline through an epidural catheter inserted at lumbar level. haemodynamic parameters were assessed along with APGAR score for neonatal status and maternal satisfaction was documented.RESULTSRopivacaine with dexmedetomidine was found to be a superior combination than plain ropivacaine in providing labour analgesia. The mean drug requirement in RD group (27.46 mL) was less than RS group (30.93 mL). Duration of labour is less in RD group (180.93±21.26 min) compared to RS group (199.49±24.63 min). Neonatal outcome and maternal satisfaction were better in RD group than RS group.CONCLUSIONSMaternal satisfaction with better analgesia was seen when dexmedetomidine was added to ropivacaine group owing to significant results in VAS scores in both the groups also duration of labour was reduced in RD group.

To Compare the Effects of Intermittent versus Continuous Administration of Epidural Ropivacaine with Fentanyl for Labour Analgesia at Govt. T.D. Medical College, Alappuzha

Labour analgesia improving the maternal and neonatal outcome is time proven. Primary objective was to compare the quality of analgesia using visual analogue scale and secondary objectives were to assess the progress of labour, incidence of instrument assisted delivery, total dose of drug used in each technique, neonatal outcome and the incidence of maternal side effects.METHODSA prospective interventional study was done in 40 willing Primigravida (20 in each group) with uncomplicated singleton term gestation admitted to labour room during the period of 1 year after obtaining ethical clearance. Sample size calculated was 25 using the formula 4pq/d2 with 80 % power. Statistical analysis was done by SPSS v16 software. Association was tested using chi square test for qualitative variables and quantitative variables was tested using independent sample t test. Statistical significance between the VAS scores was tested using Mann Whitney test.RESULTSDemographic variables, pain scores, motor block and neonatal outcome were comparable in both the groups. The total drug requirement (p-0.5) and duration of second stage (p-0.08) were less and incidence of hypotension (p - 0.29) and rescue dose requirement (p-0.6) was more in intermittent bolus group. Instrumental delivery was higher in continuous infusion group. All parturients developed urinary retention.CONCLUSIONSLow volume of 0.2% ropivacaine with 2 mcg/mL fentanyl was effective in alleviating labour pain. Both techniques were equally effective and can be recommended for labour analgesia.

Parturient satisfaction with labour epidural and factors affecting satisfaction scores: experiences from a tertiary centre in Southern India

Background: Labour analgesia though widely practised is still not routinely administered to all parturients in India. We conducted this historical observational cross-sectional study to assess parturient knowledge and factors affecting satisfaction in those who received epidural labour analgesia; aiming at improving the services.Methods: All parturients requesting epidural labour analgesia have the catheter sited and the drug administered as per institutional protocols. A feedback form is given to these parturients, postnatally. The form consists of questions regarding her knowledge of and experience with labour analgesia, including her satisfaction score on a scale of 0 to 10. Author collected these forms and analyzed them along with information from the labour epidural register and the discharge summary.Results: The mean satisfaction score was 7.1 (SD- 2.28). 46 parturients (31.08%) had ‘low satisfaction’ (<7 score) and 102 parturients (68.9%) had ‘high satisfaction’ (≥7 score). The timing of initiation of epidural analgesia within the parturients expectations and adequate analgesia were two factors that were found to affect satisfaction scores, with statistically significant values (p=0.002 and p=0.006 respectively). Those with a very short or very long duration of labour analgesia, were more likely to give less satisfaction scores (p=0.023 and p=0.002). Only 30% of parturients had heard of labour analgesia in the past.Conclusions: In this setting good analgesia and receiving it on time are of utmost importance in those receiving epidural labor analgesia, emphasising the need for adequate analgesia and prompt initiation of the same.

A Comparison of Low – Concentration Ropivacaine (0.075%) with Fentanyl Versus Bupivacaine (0.05%) with Fentanyl for Labour Epidural Analgesia

Introduction: Providing effective as well as safe analgesiato the parturients in labour is always a concerned for theanaesthesiologists. We conducted this study to compare theanalgesic efficacy and fetomaternal outcome of ropivacaineand bupivacaine at equianalgesic dose with fentanyl in lowdose infusion.Material and Methods: This prospective, single blind studywas carried on 60 nulliparous parturients of ASA grade Iand II, with uncomplicated singleton, term pregnancy. Thepatients were randomly divided into two groups, to receivebolus dose of either 20 ml of 0.075% Ropivacaine and 0.05%Bupivacaine with fentanyl 2 µg/ml in Group RF and GroupBF respectively, followed by infusion at the rate of 10ml/hr.Onset of analgesia, motor block, maternal hemodynamics,mode of delivery and foetal outcome was assessed.Results: Visual Analog Scale (VAS) score < 3 was achievedin 25 min in Group RF as compared to 30 min in Group BF. At30 min, 77% parturients achieved T10 as compared to 50% ingroup BF. Maternal haemodynamics, APGAR score, umbilicalcord blood analysis was comparable in both the groups. Noneof the patients had motor block in both groups. The percentageof instrumental delivery was more in Group RF.Conclusions: The onset of analgesia was faster in Group RFas compared to Group BF. However once the analgesia wasestablished, both the groups had effective and satisfactoryanalgesia throughout the labour with good foetal outcome.The incidence of instrumental delivery was more in Group RF.

Outcome of labor with epidural analgesia in primigravida at term

Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look into the effects of labour analgesia on maternal and fetal outcomes and compare the same with that of opioid analgesics.Methods: It was a prospective randomized controlled trial on 100 patients where parturients were randomly allocated to either group 1-( n=50 patients) who received epidural analgesia or group 2 (n=50) who received intramuscular tramadol. The two groups were compared for duration of labour, analgesic efficacy as assessed by using Visual Analogue Scale (VAS) ,type of delivery – normal/instrumental/operative interventions ,1 and 5 min neonatal Apgar score and  neonatal breast-feeding behavior between the two groups.Results: Epidural analgesic gave better pain relief than tramadol which was found to be stastically significant (p<0.001) on comparing the VAS scores and also gave statistically significantly higher satisfaction levels. Duration of both first and second stage of labor was comparable between the two groups and instrumental deliveries and caesarean sections were also comparable to that in tramadol group. There was a trend of  higher  neonatal  Apgar scores   in the  epidural group than in the  tramadol group.Conclusions: Use of effective analgesia in labour, does not prolong second stage of labor and may facilitate good labour outcome both for the mother and the fetus and should be offered to patients in   tertiary setups and equipped centres when the patients are apprehensive about labor pains.

Evaluation of pain relief and satisfaction in women using epidural analgesia in labour

Background: Pain during childbirth is the most severe pain women may experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour.Methods: This retrospective study was carried out at Omega Hospital, Nagpur in 50 women in labour who demanded epidural analgesia for pain relief. It was carried out to determine extent of pain relief and overall satisfaction in women using epidural analgesia.Results: In present study, out of 50, 28 (56%) patients delivered by normal vaginal delivery, 14 (28%) patients delivered by cesarean section, 8 (16%) patients had vacuum delivery while in no patient forceps were applied. In first stage,36 (72%) patients had zero score (no pain), 13 (26%) patients had 1-3 score (mild pain) while 1 (2%) patient had 4-6 score (moderate pain) after epidural analgesia. That means epidural analgesia had very good effect in first stage in terms of pain scoring. In second stage, 13 (26%) patients had zero score (no pain), 31 (62%) had 1-3 score (mild pain) while 6 (12%) had 4-6 score (moderate pain) after epidural analgesia. That means epidural analgesia had good effect in second stage in terms of pain scoring. In terms of satisfaction, 11 (22%) patients said it was excellent, 27 (54%) patients said it was good, 8 (16%) patients said it was average while 4 (8%) said it was poor. Apgar score for all babies at 1 min and 5 min was very good. It was ≥7 in all 50 (100%) of newborn babies.Conclusions: Epidural labor analgesia gives significantly less pain scores and has better maternal satisfaction. It is not associated with increased rate of instrumental vaginal delivery or cesarean delivery. Patients had excellent neonatal outcome.

A study of progress of labour and feto-maternal outcome with epidural labour analgesia

Background: Experiencing labour pain and giving birth to infant is normal physiological process. In the present study the merits and demerits of epidural analgesia and its effect on progress of labour and its outcome is evaluated. Materials and methods: The present study on epidural analgesic technique for painless labour had been carried out at King George Hospital, Visakhapatnam, in cooperation with Department of Anesthesia, King George hospital. A total number of 100 patients were studied (50 cases and 50 controls). They were divided into total two groups. GROUP – 1 (Study Group) included 50 low risk primigravida, fulfilled the inclusion criteria. In this group cases received epidural analgesia. GROUP – 2 (Control Group) included 50 low risk primigravida in active phase of labour, fulfilled the inclusion criteria but were not willing for epidural analgesia. Results: 50 healthy parturient receiving epidural analgesia were compared with 50 parturient in the control group. Maximum number of parturient in both groups belong to age group of 18 to 25 years. The parturient in both groups were comparable as regards to their age distribution. Mean duration of first stage of labour in both cases and control group was compared and there was no significant difference in both groups. p value >0.05, which was non-significant. 80% of parturient in cases has pain score between 1 and 2 in control group none of the parturient has pain score of <7. Conclusions: Labour pain is associated with biochemical and physiological changes that may have adverse effects on both the mothers and the fetus. Epidural analgesia is an excellent method of relieving labour pains.

Combined spinal-epidural analgesia in labour: its effects on delivery outcome / Analgesia combinada raquiperidural em trabalho de parto: seus efeitos sobre o desfecho do parto

ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55) or Non-CSE (n = 55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

RESUMO JUSTIFICATIVA E OBJETIVOS: A analgesia combinada raquiperidural (RP) tornou-se uma opção cada vez mais popular para o trabalho de parto tradicional devido ao seu rápido início de ação e ao resultado confiável. Este foi um estudo prospectivo de amostragem conveniente para determinar os efeitos da RP sobre o desfecho do parto. MÉTODOS: Foram incluídas 110 parturientes primigestas saudáveis, com gestação única de ≥ 37 semanas e na fase ativa do trabalho de parto. As pacientes foram designadas para os grupos RP (n = 55) ou não RP (n = 55) com base em seus consentimentos para a analgesia combinada RP. As parturientes do grupo não RP receberam outros métodos de analgesia para o parto. As durações do primeiro e segundo estágio do trabalho de parto, as taxas de parto vaginal instrumental e cesariana de emergência e os escores de Apgar foram comparados. RESULTADOS: A média de duração do primeiro e segundo estágio do trabalho de parto não foi significativamente diferente entre os dois grupos. As taxas de parto instrumental não foram significativamente diferentes entre os grupos, RP (11%) versus não RP (16%). A incidência ligeiramente maior de cesariana no grupo RP (16% versus 15% no não RP) não foi estatisticamente significativa. O desfecho neonatal em termos de índice de Apgar foi inferior a 7. CONCLUSÃO: Não houve diferenças significativas em relação à duração do trabalho, às taxas de parto vaginal instrumental e cesariana de emergência e ao desfecho neonatal em parturientes que receberam RP para analgesia de parto em comparação com aquelas que não receberam.

The effect of remifentanil for labor analgesia and its effect on pregnancy outcome / 中国综合临床

Objective To investigate the effects of remifentanil patient controlled intravenous analgesia (PCIA) as a labour analgesic and the effects of neonate.Methods One hundred and thirty-five vaginal delivery primiparas were randomly divided into 3 groups: natural labor group, remifentanil l(RI) group and remifentanil Ⅱ(R Ⅱ) group,each group of 45 cases.RⅠ group and R Ⅱ group were treated with remifentanil at initial dose of 0.5 μg/kg and background dose of 0.05 μg/(kg? min) respectively.Patients in RⅠ group were treated with bolus dose of 0.2 μg/kg.Patients in R Ⅱ group were treated with bolus dose of 0.5 μg/kg.The lock time was 2 minutes.The analgesic effect of before analgesia immediate, and 5,30,60 min after analgesia were evaluated by visual analogue scale (VAS).And the oxytocin usage rate, cesarean section rate, neonatal Apgar score were assessed.The adverse drug reactions were recorded.Results After 5,30,60 min used drug , compared with natural labor group((9.52±0.32) sore, (9.58±0.27) sore, (9.53±0.28) sore) ,the VAS were decreased in the group of RⅠ((7.19±0.53) sore, (5.82±0.48) sore, (5.25±0.54) sore) and R Ⅱ (P＜0.05).Compared with RⅠ group,the VAS were decreased in the group of R Ⅱ (P＜0.05).There were no differences of oxytocin usage rate,cesarean section rate,neonatal Apgar score.In the remifentani] group, there were 2 cases of pruritus and 1 cases of vomiting;the systolic blood pressure and heart rate were in the normal physiological range after analgesia.Abnormal fetal heart rate was not found during the routine fetal heart monitoring during analgesia.Conclusion Patient-controlled intravenous analgesia with remifentanil is effective in labour analgesia and at initial dose of 0.5 μg/kg,background dose of 0.05 μg/(kg? min) and bolus dose of 0.5 μg/kg for 2 min.

Maternal Outcome in Programmed Labour -a Randomized Control Trial.

Objectives : To compare the duration of labour and maternal outcome in programmed labour protocol and conventional labour protocol followed in our hospital. Materials and Methods : Sixty consecutive uncomplicated primigravida with spontaneous onset of labour, at term in vertex presentation were selected and randomized into study and control groups of 30 each. Study group received programmed labour protocol and the control group received conventional labour protocol. Rate of labour progression, duration of labour, visual analog score, maternal and fetal outcome were studied. Results : 70% of the study group had excellent pain relief. The mean rate of cervical dilatation was 4.2cm/hr in study group and 1.92 cm/hr in control group . The mean duration of 1st, 2nd, 3rd stages were 140.41 mins, 21.24 mins and 6.2 mins respectively in study group as compared to 240.5 mins, 30.63 mins and 7.93 mins respectively in control group. 80 % of the women had vaginal delivery without any major adverse effects. Conclusions : Programmed labour protocol provides effective labour analgesia, augments the process of labour without adverse maternal outcome.

Primary pulmonary hypertension in pregnancy: Vaginal delivery with epidural labour analgesia.

Primary pulmonary hypertension is a very rare, progressive, incurable disease, the only curable option being heart lung transplant. When pregnancy is associated with pulmonary hypertension due to any cause, it carries very poor prognosis with mortality rate ranging from 30-50%. More risk is involved during labour & peripartum period, as labour pain with hypercarbia, hypoxia, acidosis, increases sympathomimetic responses and pulmonary vascular resistance which could be fatal to parturient. Epidural labour analgesia with painless vaginal delivery attenuates these responses & improves survival rate. It also helps in accommodating the auto transfused blood in postpartum period due to controlled vasodilatation & so avoiding right ventricular failure. Case report: We report a case of a primigravida patient with primary pulmonary hypertension who was advised therapeutic abortion, but she continued with pregnancy and underwent vaginal delivery with epidural analgesia & was continuously haemodynamically monitored non-invasively during labour & postpartum period.