LABOUR ANALGESIA- A COMPARISON OF EPIDURAL BOLUS ADMINISTRATION OF 0.0625% BUPIVACAINE WITH 0.0002% FENTANYL VERSUS 0.125% PLAIN BUPIVACAINE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 12
Abstract
BACKGROUND Labour is an extremely painful process. Labour pain is of major concern since most parturients experience significant pain of extremely severe intensity. Labour pain can have deleterious effects on the mother, on the foetus and on the labour outcome. Among the current methods of obstetric analgesia, regional analgesia (the most widespread technique being epidural analgesia) offers the best effectiveness/ safety ratio. Epidural anaesthesia is an effective means of providing analgesia during labour. The increased availability of epidural analgesia and the favourable experiences of women who have had painless labour with epidural block have reshaped the expectations of pregnant women entering labour. Aims and Objectives- To compare the efficacy of epidural analgesia using 0.0625% Bupivacaine and 0.0002% fentanyl versus an epidural using 0.125% bupivacaine alone for labour analgesia. The following parameters are compared: Quality of analgesia (VAS). Duration of labour. Motor block (Bromage score). Time from epidural to delivery. Rate of operational delivery. MATERIALS AND METHODS The non-randomised controlled trial of fifty parturients who were admitted to the antenatal ward and who requested pain relief during labour and who fulfilled the recruitment criteria were selected for the study. The sample size was selected for convenience. The procedure was explained to them in detail and written consent was obtained from them. 50 women fulfilling the inclusion criteria who required epidural analgesia in labour were studied. IV access was secured, but no IV fluid load was given. The patients were shifted to the operation theatre for insertion of the epidural catheter in aseptic manner. An epidural catheter was sited at the L3 - L4 lumbar interspace using a standard midline technique with a 17-gauge Tuohy needle. Patients entered into the study in a randomised order to receive one of the study treatments. RESULTS A number of methods exist to provide pain relief to the labouring parturient. Of the regional techniques, epidural analgesia is considered the gold standard among all other techniques and it is the only technique which can provide a complete and convincing pain relief making labour a pleasurable experience. In our study, we have demonstrated that with an epidural top-up technique using 0.0625% bupivacaine with fentanyl 2 microgram/mL (Group A) analgesia was similar to that using 0.125% plain bupivacaine (Group B), but motor power was retained allowing women to mobilise. There also appeared to be beneficial effects on the progress of labour with a clinically important reduction in the length of the second stage. In our study, the patients in Group A had minimal motor blockade when compared to patients in Group B. Reduction in motor block allowing independent movement and awareness of contractions without pain has been shown to be popular with mothers. Retention of pelvic floor sensation and motor function may allow appropriate coordinated pushing during the second stage, improving rotation and descent of the foetal head through the pelvis. Epidural local anaesthetic may attenuate endogenous oxytocin production reducing uterine contractility during the second stage. Both the long second stage and instrumental delivery have associated morbidity for the mother. It poses a controversial potential risk to the baby and negatively influence maternal satisfaction with the experience of labour. Although, epidural analgesia produces excellent analgesia, this does not automatically produce maternal satisfaction with labour and less effective methods of analgesia have produced higher satisfaction with scores. We demonstrated high maternal satisfaction with both epidural solutions, which was significantly greater in bupivacaine-fentanyl group. Analgesia was established by 30 mins. in all women. Establishing analgesia with an epidural bolus is effective, but takes longer than a combined spinal-epidural technique, which has been described widely. However, it avoids the complications of deliberate dural puncture. The time difference between establishing spinal rather than epidural analgesia should be viewed in the context of the duration of labour and the potential complications of the spinal component of a combined technique. The blood pressures (both systolic and diastolic) and pulse rate recorded during the analgesia in both the groups were not statistically significant. The APGAR score observed at 1 minute and 5 minutes showed no significant neonatal depression. Complications were only few, were minor and easily manageable. CONCLUSION In our study, we have shown that establishing epidural analgesia in labour with 15 mL of 0.0625% bupivacaine combined with fentanyl 30 micrograms followed by top-ups of 10 mL of 0.0625% bupivacaine with 0.0002% fentanyl produced similar analgesia to that obtained from the same volume of 0.125% bupivacaine alone, but motor block was minimised. This may influence the progress of labour, decreasing the duration of the second stage and produce high maternal satisfaction with the experience of labour. In our study, the APGAR score observed at 1 minute and 5 minutes showed no significant neonatal depression.
Authors and Affiliations
Ramgopal Radha Krishnan, Mariappan Gomathi
Keywords
Related Articles
- EP ID EP412025
- DOI 10.14260/jemds/2018/331
- Views 72
- Downloads 0
CO-INFECTION OF PLASMODIUM VIVAX AND FALCIPARUM MALARIA IN A TERTIARY CARE HOSPITAL IN BIHAR
BACKGROUND Malaria is probably one of the oldest diseases known to mankind that has had profound impact on our history. It continues to be a huge social, economic and health problem, particularly in the tropical countrie...
ONE YEAR RANDOMISED CONTROLLED TRIAL TO COMPARE THE EFFECTIVENESS OF TRICLOSANCOATED PDS PLUS VERSUS UNCOATED PDS SUTURES IN PREVENTION OF SURGICAL SITE INFECTIONS AFTER MONOLAYER CLOSURE IN OPEN ABDOMINAL SURGERIES
BACKGROUND Surgical site infections remain one of the most frequent complications in open abdominal surgery. This study compared the effectiveness of Triclosan-coated PDS Plus and non-coated PDS II after monolayer abdomi...
A RARE CASE OF VITREOUS HEMORRHAGE AND NEOVASCULAR GLAUCOMA AS A MANIFESTATION OF NON SMALL CELL LUNG ADENOCARCINOMA WITH CHOROIDIAL METASTASIS
[b] BACKGROUND[/b]: Tumor metastasis to the eye is a rare complication of lung cancer. Metastasis to the choroid in patients with lung cancer is associated mainly with small cell carcinoma. Hemorrhage is an unusua...
A COMPARATIVE STUDY OF INFUSION DEXMEDETOMIDINE AND INFUSION MAGNESIUM SULPHATE ON ATTENUATION OF BLOOD PRESSURE SURGE IN LAPAROSCOPIC SURGERY UNDER GENERAL ANAESTHESIA
BACKGROUND The haemodynamic surge in laparoscopic surgery following carbon dioxide insufflations can be attenuated by various drugs. Dexmedetomidine, a selective-alpha-agonist depresses central sympathetic outflow produc...
STUDY OF IMPULSIVITY AND SUICIDE INTENT IN ATTEMPTED SUICIDE PATIENTS
BACKGROUND Suicide is one of the leading cause of death, both in developing and developed countries. Nowadays suicidal behaviour has been recognised as an increasing public health problem. The aim of this study is to stu...