A comparative study of feto-maternal outcome in painless labor by using clonidine, dexmedetomidine and fentanyl as adjuvant with ropivacine.An RCT

Kavita Meena; Amit Kumar; Rajesh Kumar Meena

Volume : IX, Issue : V, May - 2020

A comparative study of feto-maternal outcome in painless labor by using clonidine, dexmedetomidine and fentanyl as adjuvant with ropivacine.An RCT

Kavita Meena, Amit Kumar, Rajesh Kumar Meena

Abstract :

Context: Apprehension, anxiety and fear about the labor pains have always existed. Epidural analgesia provides effective pain relief and attenuates the adverse physiological response to pain. PCEA pump allows continuous administration of drug into the epidural space also covers differences in anesthetic requirement as patient can match dose of analgesia to amount of pain as labor progresses. Aims: Aim of our study is to evaluate and compare the analgesic effect of dexmedetomidine, clonidine and fentanyl. This study is also meant to assess the success rate of vaginal delivery and maternal satisfication. Settings and Design: randomized controlled study conducted in 60 parturient at Department of Anaesthesiology (with co‐operation of Department of Obstetrics & Gynaecology), Sir Sunderlal Hospital, and Banaras Hindu University. It is a randomized control trial Methods and Material: 60 ASA physical status I&II parturients were divided into three groups with 20 patients in each group. Group A was given PCEA of Ropivacaine 0.1% with dexmedetomidine2mcg/ml. Group B was given PCEA solution of Ropivacaine 0.1% with Fentanyl 2mcg/ml Group C was given PCEA solution Ropivacaine0.1%with Clonidine1.5mcg/ml. Outcomes for motor blockade was noted, time to onset of analgesia, time to onset of maximum analgesia, duration of analgesia, maternal complication, fetal outcome in terms of APGAR score, mode of delivery and fetal complications were noted. Statistical analysis used: Statistical analysis of data was s performed by u sing SPSS 16.0 statistic s software. Parameters including total duration of labor, total study drug requirement, pulse rate, oxygen saturation and blood pressure measurements were compared by one way analysis of variance test with Post hoc intergroup comparisons using Bonferonni�s correction. Nominal data including mode of delivery need of demand boluses and side‐effects were compared by Fisher�s exact test/ chi‐square test whichever appropriate. The critical value of �p� indicating the probability of significant difference was taken as <0.05 for comparisons. Results: motor blockade at 6 hours was 3.44� 0.15 in Group A, 3.90� 0.12 in Group B and 3.90 � 0.41 in Group C which was not significant. Onset of analgesia was fastest in Group B at 20 min which was 4.50�1.100, in Group A it was 5.35�1.089 and in Group c it was 6.05�1.356 which was highly significant with p–value 0.001. Mean no of demand bolous was least in Group B which was 2.35�0.58 which is significant, whereas in Group A it was 3.40�0.94 and in Group C it was 5.45�1.05. Mean of total infusion volume required, duration of labour, APGAR score and maternal satisfication score and incidences of side effects in all three group were similar and not significant. Conclusions: most of the parturient (93.33%) showed satisfactory response to patient controlled epidural analgesia PCEA and also wanted to receive same in future pregnancy. P CEA does not increase the incidence of forceps delivery or caesarean section or worsens the neonatal outcome. All the 3 adjuvants used in study (fentanyl, Clonidine and dexmetomedine) have the qualities of being the future in labour analgesia