Single Shot Spinal Analgesia for Labour: Bupivacaine- Pethidine versusBupivacaine-Fentanyl for Multiparous women
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Abstract
Background: The high cost of epidural services may impede its wholesale application especially in low resource setting. Single shot spinal, a cheap and effective alternative technique for alleviating labour pain, may be useful for Nigerian women in labour. Thus, we compared the effects of single-shot intrathecal bupivacaine with either fentanyl or pethidine (preservative-free) for labour analgesia in multiparous women.
Method: One hundred and twenty-two multiparous ASA 1 or 2 parturients at term requesting for analgesia in labour with cervical dilatation ≥ 4 cm were randomly assigned to receive 1.5ml of study solution containing 2.5mg hypobaric bupivacaine plus 7.5mg pethidine for BP group or 2.5mg hypobaric bupivacaine plus 25µg fentanyl for BF group. The spinal medications were administered aseptically into the subarachnoid space using any of L2/L3, L3/L4, or L4/L5 intervertebral space with the patient in sitting position. Primary outcome was the proportion of women who had adequate analgesia for labour in both groups.
Results: The patients had similar socio-demographic characteristics and baseline haemodynamic parameters. The mean onset time of spinal analgesia was shorter with BF group than the BP group (2.4 ± 0.7 min vs. 2.9 ± 1.0 min, p=0.006). All parturients achieved satisfactory analgesia with Numerical rating scale (NRS) ≤ 3 within 20 mins of institution of spinal block. The mean duration of analgesia was significantly longer in the BP group compared to the BF group (258 ± 76.2 min vs. 135.3 ± 3.4 min, p<0.001). The proportion of women in BP group that had adequate labour analgesia was 70.5% (43/61) as against 49.2% (30/61) in the BF group (p=0.026). Fewer number of women in the BP group (20/61) compared to the BF group (36/61) required additional analgesia for episiotomy repair.
Conclusion: The combination of bupivacaine-pethidine provided superior, long lasting, effective analgesia in multiparous women with good feto-maternal outcome. Pethidine added to bupivacaine should be preferred option for single shot spinal analgesia for multiparous women in labour especially in low resource countries of the world.
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