ABSTRACT
OBJECTIVES: To evaluate the clinical correlates of women who received pain relief in labour with lumbar epidural analgesia and also investigate the labour outcome. MATERIALS AND METHODS: A hospital -based case-control study conducted in a tertiary care facility in Nigeria. The clinical characteristics and delivery outcome of women who had epidural analgesia in labour were compared to those without. RESULTS: The utilisation rate of labour epidural analgesia during the study period was 13/1000 women. Tertiary education was significantly higher among women who had epidural analgesia in labour (22.7% vs 3.4%, p=0.0009). There were no statistically significant differences between women who had labour epidural analgesia and the controls in terms of labour and delivery by caesarean section. The second stage of labour was prolonged in women who received epidural for pain relief in labour (p=0.005). The neonatal indices (Mean birth weight or Apgar score<7 in first minute) were similar. CONCLUSION: This study suggests that labour epidural analgesia is not associated with increased caesarean section and adverse foetal outcome. This is of value in increasing the acceptance of this service by pregnant women in Nigeria.
Subject(s)
Analgesia, Epidural , Pregnancy Outcome , Case-Control Studies , Cesarean Section/statistics & numerical data , Female , Humans , Nigeria , Pregnancy , Tertiary Care CentersABSTRACT
AIMS AND OBJECTIVES: This study determined the quality of perioperative analgesia and side effect profile of spinal bupivacaine plus pethidine for caesarean section. PATIENTS AND METHODS: Patients were randomised to receive 2.0mL of bupivacaine + pethidine 7.5mg or 2.0mL bupivacaine + saline of equal volume. Spinal anaesthesia was instituted at L2/3, L3/4 or L4/5 using a 25G pencil point spinal needle. Heart rate, blood pressure and oxygen saturation were monitored. Timelines such as time of injection of study medication, skin incision, delivery time, termination of surgery and time to first request for analgesia as well as complications were noted. Demographic characteristics were also recorded. RESULTS: 50 patients were studied in 2 groups and the demographic characteristics were similar. Addition of pethidine resulted in block height greater than T6 and longer duration of analgesia (256.9 ± 112.2 min.) compared with the saline group (160.5 ± 65.0 min; p = 0.0005). Maternal hypotension occurred more in the pethidine group (10/25 vs 2/25; p = 0.01). Peritoneal irritation and inadequate anaesthesia were more frequent in the saline group. Nausea and vomiting and drowsiness were mild and occurred only in the pethidine group. In the Post Anaesthetic Care Unit (PACU), more patients reported pain in the saline group (p = 0.002). CONCLUSION: Bupivacaine with pethidine 7.5mg resulted in better quality of anaesthesia, longer postoperative analgesia with acceptable side effect profile. This will be of value in the management of post-caesarean section pain particularly in the resource poor setting.
