The effects of epidural analgesia in normal labour

Authors

  • Vallur Swetha Reddy Department of Obstetrics and Gynecology, PES Institute of Medical Sciences, Kuppam, Andhra Pradesh, India
  • U. S. Sabitha Department of Obstetrics and Gynecology, PES Institute of Medical Sciences, Kuppam, Andhra Pradesh, India
  • L. Krishna Department of Obstetrics and Gynecology, PES Institute of Medical Sciences, Kuppam, Andhra Pradesh, India
  • Vimala . Department of Obstetrics and Gynecology, PES Institute of Medical Sciences, Kuppam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20183414

Keywords:

Bupivacaine, Epidural analgesia, Fentanyl, Labour, Nulliparous, Parturient

Abstract

Background: Epidural analgesia is considered to be gold standard technique for labour analgesia but is claimed to prolong labour. Previous studies have evaluated epidural analgesia versus systemic opioids to no analgesia. The present study evaluated the effect of epidural analgesia on duration of labour compared to no analgesia.

Methods: Sixty primigravida with full term-singleton, vertex presentation in spontaneous labour were included in the study. Parturient willing for epidural analgesia were allocated as epidural group (n=30), rest served as control. The intervention in active stage of labour included 10 ml of Inj. Bupivacaine 0.125% and Inj. Fentanyl 100μg and maintenance with infusion of Inj. Bupivacaine 0.125% and Inj. Fentanyl 2μg/ml added at a rate of 6-8 ml/hr. Duration of the first two stages of labour, patient satisfaction, side effects, number of instrumental vaginal/ vacuum-assisted deliveries, and neonatal APGAR score were recorded.

Results: The mean duration of first stage of labour was shorter in epidural group (250.17±106.33 minutes) compared with control (302.00±111.99 minutes), (p= 0.071). The mean duration of second stage in epidural group was (18.73±6.82 minutes) compared with control (18.33±14.53 minutes) was not significant (p= 0.892). Although instrumental vaginal delivery rate was greater in the epidural group (6.7%) as compared to control (3.3%), (p=1.000). Pain score (VAPS) varied between1-3 and 4-10 in epidural group and control respectively (p< 0.001). The APGAR scores at 5 min and neonatal ICU admissions were statistically comparable.

Conclusions: Epidural analgesia with Bupivacaine and Fentanyl results in good pain relief with undue prolongation of labour.

References

Committee on Obstetrics: Maternal and Fetal Medicine. Pain Relief during Labor (Committee Opinion No. 118). Washington, D.C., American College of Obstetricians and Gynecologists, 1993.

Srivastava U, Gupta A, Saxena S, Kumar A, Singh S, Saraswat N, Mishra AR, Kannaujia A, Mishra S. Patient controlled epidural analgesia during labour: effect of addition of background infusion on quality of analgesia and maternal satisfaction. Indian J Anaesthesia. 2009 Dec;53(6):649.

Silva M, Halpern SH. Epidural analgesia for labor: Current techniques. Local and regional anesthesia. 2010;3:143.

Bandyopadhyay KH, Afzal M, Mishra AK, Paul A. Labor epidural analgesia: Past, present and future. Indian J Pain. 2014 May 1;28(2):71.

Ranasinghe JS, Birnbach D. Current status of obstetric anaesthesia: Improving satisfaction and safety. Indian J Aanaesthesia. 2009 Oct;53(5):608.

Leighton BL, Halpern SH. The effects of epidural analgesia on labour, maternal, and neonatal outcomes: a systemic review. Am J Obstet Gynecol. 2002;186:S69-77.

Goetzl LM. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gyneclogist Number 36, July 2002. Obstetric analgesia and anesthesia. Obstet Gynecol. 2002;100(1):177-91.

Tsen LC, Thue B, Datta S, Segal S. Is combined spinal–epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia?. Anesthesiology: J Am Soc Anesthesiologists. 1999 Oct 1;91(4):920-5.

Olofsson CH, Ekblom A, Ekman‐Ordeberg G, Irestedt L. Obstetric outcome following epidural analgesia with bupivacaine‐adrenaline 0.25% or bupivacaine 0.125% with sufentanil‐a prospective randomized controlled study in 1000 parturients. Acta Anaesthesiologica Scand. 1998 Mar;42(3):284-92.

Thorburn J, Moir DD. Extradural analgesia: The influence of volume and concentration of bupivacaine on the mode of delivery, analgesic efficacy and motor block. Br J Anaesthesia. 1981 Sep 30;53(9):933-9.

Mousa WF, Al-Metwalli RR, Mostafa M. Epidural analgesia during labor-0.5% lidocaine with fentanyl vs. 0.08% ropivacaine with fentanyl. Middle East J Anaesthesiol. 2010 Feb;20(4):521-7.

Nafisi S. Effects of epidural lidocaine analgesia on labor and delivery: a randomized, prospective, controlled trial. BMC Anesthesiol. 2006 Dec;6(1):15.

Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesthesia. 2010 Dec 1;105(suppl_1):i50-60.

Roberts CL, Algert CS, Douglas I, Tracy SK, Peat B. Trends in labour and birth inter-ventions among low-risk women in New South Wales. Aust NZ J Obstet Gynaecol. 2002;42:176-181.

Liu EH, Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. Br Med J. 2004 Jun 10;328(7453):1410.

Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2005 Jan 1;4(6).

Halpern SH, Stephen SM. Epidural analgesia for labor: Current techniques. Local and Regional Anesthesia. 2010;3:143–53.

Morgan-Ortiz F, Quintero-Ledezma JC, Perez-Sotelo JA, Trapero-Morales M. Evolution and quality of care during labor and delivery in primiparous patients who underwent early obstetrical analgesia. Gynecol Obstet Mexico. 1999 Nov;67:522-6.

Anwar S, Anwar MW, Ahmad S. Effect of epidural analgesia on labour and its outcomes. J Ayub Med Coll Abbottabad. 2015 Jan-Mar;27(1):146-50.

Agrawal D, Makhija B, Arora M, Haritwal A, Gurha P. The effect of epidural analgesia on labour, mode of delivery and neonatal outcome in nullipara of India, 2011-2014. J Clin Diag Res: JCDR. 2014 Oct;8(10):OC03.

Fyneface-Ogan S, Mato CN, Anya SE. Epidural anesthesia: views and outcomes of women in labor in a Nigerian hospital. Ann African Med. 2009;8(4).

Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT, et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Eng J Med. 2005 Feb 17;352(7):655-65.

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Published

2018-08-27

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Original Research Articles