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.

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.