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• W2899199859 abstract "INTRODUCTION:Labour is an extremely painful process. Labour pain is of majorconcern since most parturients experience significant pain of extremely severeintensity. Labour pain can have deleterious effects on the mother, on the foetusand 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 favorable experiences ofwomen who have had painless labor with epidural block have reshaped theexpectations of pregnant women entering labor.Compared with other forms of pain relief, epidural analgesia is associated withthe highest level of maternal satisfaction. Despite providing excellent pain reliefduring labour, epidural analgesia using local anaesthetic agents alone producemotor block in up to 85% of patients, reduces maternal satisfaction withanalgesia, and is associated with a prolonged second stage and increasedincidence of instrumental delivery. Epidural opioids offer the possibility ofanalgesia without motor block but when used alone do not provide satisfactoryanalgesia throughout labour. Adding an opioid to local anaesthetic solutions canprovide effective analgesia with bupivacaine sparing and a reduction in motorblock.The use of either an intermittent bolus or a continuous infusion of local anesthetic(with or without an opioid) is considered to provide similar analgesic efficacy andno measurable outcome differences. The addition of an opioid to the localanesthetic epidural bolus or infusion has become a highly popular technique, andthe combination is believed to influence the duration and quality of laboranalgesia. The efficacy and duration of epidural opioid alone is consideredinferior to epidural local anesthetic, but the benefits of an opioid should outweighthe side effects such as nausea, pruritus, and sedation. An epidural opioidlocalanesthetic combination may enhance the duration and quality of pain reliefat less intense motor blockade and contribute to the good progress of labor andvaginal delivery.We conducted this study to compare the efficacy of a mobileepidural using 0.125% bupivacaine and 0.0002% fentanyl versus a conventionalepidural using 0.25% bupivacaine for labour analgesia.AIM:1. To compare the efficacy of epidural analgesia using 0.125% bupivacaine and 0.0002% fentanyl versus an epidural using 0.25% bupivacaine alone for labour analgesia.The following parameters are compared:1.Quality of analgesia (VAS),2.Duration of labour,3.Motor block (Bromage score),4.Time from epidural to delivery.MATERIALS AND METHODS:Study Centre:Institute of social obstetrics, Kasturba Gandhi Hospital, Madras MedicalCollege, Chennai.Study Design:Randomised, Prospective, Comparative, Parallel group study.Study Period: August 2008 to November 2008.Study Population: Fifty parturients who were admitted to the antenatal ward and who requested pain relief during labor and who fulfilled the recruitment criteria were selected for the study. The procedure was explained to them indetail and written consent was obtained from them.Informed Consent:Written informed consent was obtained from each patient in theprescribed format prior to performance of any study related procedures: beforephysical examination, laboratory screening or any other investigational procedureand before administration of any study related medication. The patients weregiven full information about the nature, procedure and importance of the study.Inclusion Criteria:1.ASA Status I & II2.Females in the age group from 18 to 30 years,3.Primigravida,4.Adequate gynaecoid pelvis,5.Cervical dilatation less than 4 cm.Exclusion Criteria:1. Patient refusal,2. Patients with pregnancy induced hypertension, heart disease, anaemiaand other complications of pregnancy,3.Cervical dilatation greater than 4 cm,4.Patients who received systemic opioids within 4 hours of epiduralRequest,5.Coagulopathy.6.Patients with clinically significant renal, hepatic, cardiovascular,haematopoetic, pulmonary, gastrointestinal, nervous or endocrinedisorders7. Patients unwilling or unable to comply with the study proceduresRESULTS:A total of 180 patients were screened for the study. 50 patientswho fulfilled the inclusion criteria were enrolled for the study and were divided into two groups -GROUP A: 25 patients,GROUP B: 25 patients.Patients were randomly allocated to groups A or B to receiveeither of the two study therapies –either epidural bolus administration of 0.1%bupivacaine with 0.0002% fentanyl (Group A) or epidural bolus administration of0.25% plain bupivacaine (Group B). All patients in both the groups completedthe study. There were no drop outs in the study.SUMMARY:In our study, comparison of epidural bolus administration of 0.25% bupivacaineand 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour wasdone. Patients were randomized to enter either group A treatment arm or groupB treatment arm. Group A received bolus doses of 0.1% bupivacaine withfentanyl 2 micrograms/ml while group B received 0.25% plain bupivacaine.Analgesia provided by both techniques was found to be similar. Women in groupA retained motor power in their legs. Motor Block was minimized in Group A.Duration of labour and time from insertion of the epidural to delivery was similarin both groups, but in group A, duration of the second stage was significantlyshorter. In addition, maternal satisfaction with epidural analgesia was higher ingroup A.Both the treatment arms had lesser impact on the haemodynamics.Complications were only few, were minor and easily manageable.CONCLUSION:In our study, we have shown that establishing epidural analgesia in labour with 15ml of 0.1% bupivacaine combined with fentanyl 50 microgram followed by topupsof 10ml of 0.1% bupivacaine with 0.0002% fentanyl, produced similar analgesia to that obtained from the same volume of 0.25% bupivacaine alone, but motor block was minimized. 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." @default.
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• W2899199859 date "2009-03-01" @default.
• W2899199859 modified "2023-09-24" @default.
• W2899199859 title "Labour Analgesia: Comparison of Epidural Bolus Administration of 0.125% Bupivacaine with 0.0002% Fentanyl Versus 0.25% Plain Bupivacaine" @default.
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