A PROSPECTIVE STUDY TO COMPARE SINGLE DOSE INTRATHECAL COMBINATION OF BUPIVACAINE AND MORPHINE WITH FENTANYL, BUPIVACAINE AND MORPHINE FOR LABOUR ANALGESIA
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 31
Abstract
BACKGROUND Advances in the field of labour analgesia have tread a long journey from the days of inhalation to the present-day practice. Low dose neuraxial blocks with local anaesthetic or opioids or combination of two give superior analgesia with lesser side effects and facilitate ambulation. MATERIALS AND METHODS This study was a non-randomised, controlled trial. There were 50 parturients of ASA physical status I or II with a term singleton foetus in a vertex position without any comorbidity were randomly divided into two groups of 25 each. Spinal analgesia was administered at L3-L4 or L4-L5 using a pencil point 25-G spinal needle in sitting position. Group I received injection Morphine 100 mcg + Inj. Bupivacaine 2.5 mg (.25%) and Group II received Inj. Fentanyl 15 mcg + 50 mcg Morphine + Inj. Bupivacaine 2.5 mg (.25%) intrathecally. We monitored changes in haemodynamics, duration of labour and degree of pain using VAP score (0-100 mm). Neonatal outcome was assessed by Apgar score at 1, 5 and 10 minutes interval. Maternal satisfaction and side effects like pruritus, nausea and hypotension were monitored. Since the calculated sample size was too high and thereby not feasible to include in this limited period of study, we had to limit the sample size for convenience. RESULTS Pain score was significantly less (‘P’ < 0.5) in Group II at 5, 60 and 120 minutes in both primigravida and multigravida. Mean duration of labour is comparable in active 1st and 3rd stage in both groups and it is significantly prolonged in 2nd stage of labour in Group I, i.e. 90.00 +/_ 41.23 minutes as compared to 58.55 +/_ 24.27 minutes in Group II. Apgar score was between 9 and 10 at 0, 1, 5 and 10 minutes in both groups. Pruritus was the most frequent side effect in 76% and 72% in Group I and II respectively. 32% patients in Group I and 24% patients in Group II were unsatisfied. CONCLUSION We conclude that a single dose spinal block with Fentanyl 15 mcg + 50 mcg Morphine + Inj. Bupivacaine 2.5 mg (.25%) provide a rapid onset, profound analgesia with less side effects and good maternal satisfaction without affecting neonatal outcome.
Authors and Affiliations
Jyoti Sharma, Sanjeev Kumar
Keywords
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- EP ID EP539121
- DOI 10.14260/jemds/2018/780
- Views 86
- Downloads 0
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