Effect of single low dose intrathecal labor analgesia on maternal and fetal outcome

Authors

  • Poonam Samyal Department of Obstetrics and Gynecology, Kamla Nehru Hospital for Mother and Child, Indira Gandhi Medical College (I.G.M.C.), Shimla, Himachal Pradesh, India
  • Rama Thakur Department of Obstetrics and Gynecology, Kamla Nehru Hospital for Mother and Child, Indira Gandhi Medical College (I.G.M.C.), Shimla, Himachal Pradesh, India
  • Rohini Rao Department of Anesthesiology, Indira Gandhi Medical College (I.G.M.C.), Shimla, Himachal Pradesh, India
  • Gian Chauhan Department of Obstetrics and Gynecology, Kamla Nehru Hospital for Mother and Child, Indira Gandhi Medical College (I.G.M.C.), Shimla, Himachal Pradesh, India
  • Sharad Kaushik Department of Anesthesiology, Indira Gandhi Medical College (I.G.M.C.), Shimla, Himachal Pradesh, India
  • Anu B. Chandel Department of Obstetrics and Gynecology, Kamla Nehru Hospital for Mother and Child, Indira Gandhi Medical College (I.G.M.C.), Shimla, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20194890

Keywords:

APGAR score, Intrathecal labor analgesia, Local anesthesia, Neonatal resuscitation, Programmed labor, Rescue analgesia

Abstract

Background: Labour is one of the most painful experiences women encounter during their lifetime and the experience is different for each women. Aim of the study was to evaluate the effect of low dose intrathecal labour analgesia using fentanyl, bupivacaine and morphine on maternal and fetal outcome.

Methods: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1 (N=50) received intrathecal labor analgesia using. Fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg) and Group 2 (N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia . Progress of labor, duration of analgesia, and neonatal APGAR score were recorded. Feto-maternal and neonatal outcomes were studied and compared between the two groups.

Results: The mean duration of analgesia in group1 was 238.96±21.888 min whereas the mean duration of analgesia in group 2 was 98.4±23.505 min. The difference was significant P value 0.00. One out of 50 (2%) of the parturients required rescue analgesia in Group 1. On the contrary all 44 parturients in Group 2 required rescue analgesia. Difference was significant (p value=0.00) However duration of the stages of labor, operative and instrumental deliveries and APGAR score did not differ in the two groups.

Conclusions: Single shot intrathecal labor analgesia is a safe, effective, reliable, cheap and satisfactory method of pain relief for labor and delivery. Moreover, it is devoid of major side effects.

References

Kuczkowski KM, Chandra S. Maternal satisfaction with single-dose spinal analgesia for labor pain in Indonesia: a landmark study. J Anesth. 2008;22(1):55-8.

Fyneface-Ogan S, Gogo Job O, Enyindah CE. Comparative effects of single shot intrathecal bupivacaine with dexmedetomidine and bupivacaine with fentanyl on labor outcome. ISRN Anesthesiol. 2012;2012.

Westgren M, Lindahl SGE, Norden NE. Maternal and fetal endocrine stress response at vaginal delivery with and without an epidural block. J Perinatal Med. 1986:235-41.

Viitanen H, Viitanen M, Heikkila M. Single-shot spinal block for labour analgesia in multiparous parturients. Acta Anaesthesiol Scandinavica. 2005;49(7):1023-9.

Tshibuyi PN, Olang POR, Ogutu O, Chokwe TM. A Comparative study on the efficacy of two regimens of single-shot spinal block for pain relief in women presenting in established labour. East African Med J. 2013;90:12-8.

Nelson KE, Rauch T, Terebuh V, D’Angelo R. A Comparison of intrathecal fentanyl and sufentanil for labor analgesia. Am Soc Anesthesiol. 2002;96:1070-3.

Mathur P, Jain N, Prajapat L, Jain K, Garg D, Khandelwal V. Effect of intrathecal analgesia using fentanyl and bupivacaine on progress of labor. J Obstet Anaesth Crit Care. 2018;7:47-51.

Owen MD, Ozsarac O, Sahin S, Uckunkaya N, Kaplan N, Magunaci I. Low-dose clonidine and neostigmine prolong the duration of intrathecal bapivacaine- fentanyl for labor analgesia. Am Soc Anaesthesiol. 2000;92(2):361-6.

Zhang J. Re-assessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002;187:824-8.

Yeh HM, Chen LK, Shyu MK, Lin CJ, Sun WZ, Wang MJ, et al. The addition of morphine prolongs fentanyl-bupivacaine spinal analgesia for the relief of labor pain. Anaesth Analg. 2001;92:665-8.

Hess PE, Vasudevan A, Snowman C, Pratt SD. Small dose bupviacaine-fentanyl spinal analgesia combined with morphine for labor. Anaesth Analg. 2003;97:247-52.

Anabah T, Olufolabi A, Boyd J, George R. Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation. Southern Af J Anaes Analg. 2015;21(1):19-22.

Bilge A, Müge A, Ahmet G, Burcu KK, Özlem M. Comparison of different bupivacaine and fentanyl combinations when used with a single shot spinal block for labor analgesia. J Anesth Clin Res. 2017;7(8):1-3.

Dani C, Perugi S, Fontanelli G, Bertini G, Pratesi S, Buonocore G, et al. Effects of epidural and systemic maternal analgesia in term infants: the NoPiL study. Frontiers in Biosci (Elite Edition). 2010;2:1514-9.

Downloads

Published

2019-10-23

Issue

Section

Original Research Articles