A Double Blind Comparative Study between Intrathecal Bupivacaine and Intrathecal Fentanyl as the Initial Dose of Combined Spinal Epidural Technique for Labour Analgesia.

Dr. Rekha Kumari; Dr. Madiha Shadab; Dr. Anil Kumar; Dr. Shafqat Afrin; Dr. Debarshi Jana

Volume : IX, Issue : VI, June - 2020

A Double Blind Comparative Study between Intrathecal Bupivacaine and Intrathecal Fentanyl as the Initial Dose of Combined Spinal Epidural Technique for Labour Analgesia.

Dr. Rekha Kumari, Dr. Madiha Shadab, Dr. Anil Kumar, Dr. Shafqat Afrin, Dr. Debarshi Jana

Abstract :

Introduction: Labour analgesia techniques is the most widely practised procedures of pain management performed by an anaesthesiologist and are requested by the obstetrician colleagues as well as the parturient mothers. Presently, Combined Spinal Epidural (CSE) is the most popular and effective technique of Labour Analgesia to render the mother pain free. This technique has two parts. Our study is primarily concerned with the first part of CSE for the comparison of drugs. The aim of the study was to compare the efficacy between a small and fixed doses Fentanyl (25μgm) and Hyperbaric 0.5% Bupivacaine (2.5mg) as the initial step of CSE technique for labour analgesia. Material and methods: This double blind study aims to compare the efficacy between a intrathecal fixed dose of lipophilic opioid i.e, Fentanyl (25μgm) and a fixed dose of local anaesthetic hyperbaric 0.5% Bupivacaine ( 2.5mg) as the initial step to establish labour analgesia. 60 parturient will be divided into two group. Group I will receive intrathecal Fentanyl and Group II will receive intrathecal Bupivacaine. Onset, quality and quantity of pain relief achieved following intrathecal injection of drugs will be taken into account whereas incidence of side–effects like motor paralysis, hypotension, pruritus, foetal adycardia & respiratory depression will be noted and compared. This will indicate which drug will be more preferable as a sole drug for the initial intrathecal component of CSE technique for labour analgesia. Results: The shortest time of onset of analgesia in group I was 60sec and in group II was 40sec which was statistically significant (p<0.05). The average duration to reach maximum analgesia in Group I was 5.93 � 1.68 min and in Group II was 5.30 � 1.31 min.Whereas the duration of analgesia was found varying widely. It was 54�15.16 minutes in Group I whereas 73.5�14.74 minutes in Group II. The duration ranged from 25 minutes to 80 minutes in Group I and 35 minutes to 100 minutes in Group II. This difference was statistically significant (p=0.000005).The significant side effect noted was pruritus (56.67%) in Group I and motor paralysis (80%) and hypotension (6.67%) in Group II. Conclusion: A small dose of Fentanyl is preferable to a similar small dose of Bupivacaine for the initial intrathecal administration as a part of Combined Spinal Epidural labour analgesia technique as muscle weakness prevents the mother from taking active part in second stage of labour and hypotension is non desirable.