DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172611

Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

Ashima Taneja, Kamaldeep Arora, Isha Chopra, Anju Grewal, Sushree Samiksha Naik, Geetika Sharma

Abstract


Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.

Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.

Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.

Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group.


Keywords


Epidural analgesia, Labour, Outcome, Tramadol, Vaginal delivery

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References


Long J, Yue Y. Patient controlled intravenous analgesia with tramadol for labour pain relief. Chin Med J. 2003;116:1752-5.

Hawkins JL. Epidural analgesia for labour and delivery. N Engl J Med. 2010;362:1503-10.

Jouppila R, Hollmen A. The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour. Acta Anaesth Scand. 1976;20:259-68.

Lederman RP, Lederman E, Work B, McCann DS. Anxiety and epinephrine in multiparous labor: relationship to duration of labor and fetal heart rate pattern. Am J Obstet Gynecol. 1985;153:870-7.

Shnider SM, Abboud T, Artal R, Henriksen EH, Stefani SJ, Levinson G. Maternal catecholamines decrease during labor after lumbar epidural analgesia. Am J Obstet Gynecol. 1983;147:13-5.

Lamba A, Sardana P, Kaur R. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study Int J Reprod Contracept Obstet Gynecol. 2016;5:1722-1727.

Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011:CD000331.

Bakhamees H, Hegazy E. Does epidural increase the incidence of caesarean delivery or instrumental labor in Saudi populations? Middle East J Anaesthesiol. 2007;19:693-704.

Chandnani K, Sainee, HB. Pain relief in labour: tramadol verses pentazocine. Int J Reprod Contracept Obstet Gynecol. 2013;2:186-9.

Sharma SK, Alexander JM, Messick G. Cesarean delivery; a randomized trial of epidural analgesia versus intravenous analgesia during labour in nulliparous women. Anesthesiol. 2002;96:546-51.

McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18:1007-19.

Mousa WF, Al-Metwalli RR, Mostafa M. Epidural analgesia during labor 0.5% lidocaine with fentanyl versus 0.08% ropivacaine with fentanyl. Middle East J Anesthesiol. 2010;20:521-7.

Jaitley A, Singh S, Srivastava V, Nagrath A, Prajapati N C, Singh R. A Comparison between epidural and IV tramadol for painless labor and effect on perinatal outcome. J Obstet Gynecol India. 2011;61:42-7.

Desai P, Patel P, Gupta A, Virk G K, Sinha A. Epidural analgesia in labor. J Obstet Gynecol India. 2006;56:417-22.

Impey L, Macquillan K, RCM, Lobsonm M. Eg'inral analgesia need not increase operative delivery rates. Am J Obstet Gynecol. 2000;182:358-63.

Fyneface S, Mato CN, Anya SE. Epidural anesthesia: views and outcomes of women in labor in a Nigerian hospital. Ann Afr Med. 2009;8:250-6.

Halvadia SH, Halvadia HB, Joshi RM, Upadhyaya DP. A study of feto maternal outcome of epidural analgesia during labor. Natl J Med Res. 2013;3:184-86.