Effect of intrathecal labor analgesia using fentanyl 25 ?g and bupivacaine 2.5 mg on progress of labor

Sushil Kumar; Veena Horo

Volume : VIII, Issue : II, February - 2019

Effect of intrathecal labor analgesia using fentanyl 25 ?g and bupivacaine 2.5 mg on progress of labor

Sushil Kumar, Veena Horo

Abstract :

The pain of childbirth is the most severe pain any women can endure in their lifetime. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain of the late first stage and second stage of labor arises from the descent of the fetus in the birth canal, resulting in distension and te� of tissues in the vagina and perineum. Epidurals have long been associated with increased oxytocin use, increased fetal malposition, increased rates of instrumental and caesarean delivery, and longer labors. Spinal block is cheaper as well as less technically challenging when compared to epidural and combined spinal epidural block. Intrathecal analgesia alone is useful when duration of labor can be reasonably estimated. Opioid combined with a small dose of local anesthetic provides rapid analgesia and dissipates when no longer needed.(2) In view of the above, the present study was undertaken to compare the progress of labor as the primary outcome and hemodynamic changes in the mother and fetus as secondary outcome in parturients who received intrathecal labor analgesia using bupivacaine 2.5 mg and fentanyl 25 μg to a matching group C who did not receive neuraxial analgesia during normal vaginal delivery using a partogram. Objectives of study : To evaluate the effect of intrathecal labor analgesia using fentanyl 25 μg and bupivacaine 2.5 mg on progress of labor Setting: Medical College Hospital Design: Controlled randomized trial. Statistical Analysis Used : Student t test , SPSS for windows Results :We found that single shot intrathecal analgesia using fentanyl 25 μg and bupivacaine 2.5 mg when given in the active phase of first stage of labor had rapid onset with satisfactory pain relief and minimal motor block, which completely regressed at the time of second stage of labor. It was associated with faster cervical dilation rate and no delay in the progress of labor, without significant maternal and fetal hemodynamic variation Background: The aim of this study was to evaluate the progress of labor and hemodynamic changes in the mother and fetus with intrathecal analgesia using bupivacaine and fentanyl during normal vaginal delivery. Materials and Methods: Sixty nulliparous parturients in the active phase of labor with a cervical dilatation of >3 cm were selected for this prospective study. Group SA (n = 30) received an intrathecal injection of 0.5% hyperbaric bupivacaine 2.5 mg and fentanyl 25 μg and compared with Group C (n = 30) who refused to give consent for neuraxial analgesia. Visual analog score, progress of labor, maternal hemodynamic variations, and fetal heart rate were recorded. Statistical analysis included an unpaired and paired two-tailed t-tests. Result: Duration of the active phase of first stage of labor was shortened in group SA as compared to group C (115.50 vs. 134.0 min, P < 0.05). Duration of second stage of labor was prolonged in group SA as compared to group C (18.03 vs. 10.13 min, P < 0.05). Rate of cervical dilation was faster in group SA as compared to group C (3.021 vs. 2.486 cm/h, P < 0.05). Mean visual analog score, pulse rate, and mean arterial pressure was significantly decreased as compared to the baseline in group SA. No significant changes were noted in the fetal heart rate as compared to the baseline in both groups. Conclusions: Single-shot intrathecal analgesia using fentanyl 25 μg and bupivacaine 2.5 mg in active phase of first stage of labor associated with fast cervical dilation rate and no delay in the progress of labor