Efficacy and safety of intravenous paracetamol versus intravenous tramadol for labour analgesia


  • Sania Jindal Department of Obstetrics and Gynecology, Government Medical College & Hospital, Chandigarh, India
  • Poonam Goel Department of Obstetrics and Gynecology, Government Medical College & Hospital, Chandigarh, India
  • Sukanya Mitra Department of Anaesthesia, Government Medical College & Hospital, Chandigarh, India
  • Dilpreet K. Pandher Department of Obstetrics and Gynecology, Government Medical College & Hospital, Chandigarh, India
  • Shikha Rani Department of Obstetrics and Gynecology, Government Medical College & Hospital, Chandigarh, India




Labour analgesia, Paracetamol, Visual analogue score


Background: An effective labour analgesia improves maternal and perinatal outcome and improves the course of labour.

Methods: This was a prospective, randomised study done to compare effectiveness and safety of intravenous infusion of paracetamol with tramadol when used for labour analgesia. Group A (25 parturients) received paracetamol 1000 mg and group B (25 parturients) received tramadol 1mg/Kg at 4 to 6 cm cervical dilatation. Visual analogue score for pain was assessed at the baseline, 1 hour and 3 hours of drug administration and was compared between the two groups along with various maternal and fetal outcomes.

Results: The difference in mean Visual Analogue Score (VAS) just before the drug administration was not statistically significant. However, at 1 hour of drug administration, mean VAS was significantly lower in the Group A (4.60) in comparison to Group B (5.82). The mean VAS at 3 hours was slightly lower in group A (6.35) in comparison to group B (6.65), though statistically there was no significant difference. Nausea, vomiting and sedation were found to be more in the tramadol group as compared to paracetamol group. The mean 1 and 5 minute apgar scores were found to be comparable in both the groups.

Conclusions: So, it can be concluded from our study that intravenous paracetamol may be preferred over intravenous tramadol as it is associated with better analgesic efficacy and less maternal side effects. Although both the drugs were found to have good neonatal outcome.


Ranta P, Spalding M, Kangas-Saarela T. Maternal expectations and experiences of labour pain--options of 1091 Finnish parturients. Acta Anaesthesiol Scand 1995;39(1):60-6.

Sharma S, Menia V, Bedi J, Dogra S. Labor analgesia: An unmet right of laboring women in India. J South Asian Fed Obstet Gynaecol. 2015;5(1):26–32.

Jones L. Pain management for women in labour: an overview of systematic reviews. J Evidence-Based Medi. 2012;2(3):101-2.

Lallar M, ul Anam H, Nandal R, Singh SP, Katyal S. Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labor analgesic. J Obstetr Gynecol India. 2015;65:17-22.

Duggan ST, Scott LJ. Intravenous Paracetamol (Acetaminophen). Drugs. 2009;69:101-13.

Crichton N. Visual analogue scale (VAS). J Clin Nurs. 2001;10(5):706-6.

Peabody JL. Transcutaneous oxygen measurement to evaluate drug effects. Clin Perinatol. 1979;6(1):109-21.

Morishima HO, Yeh MN, James LS. Reduced uterine blood flow and fetal hypoxemia with acute maternal stress:experimental observation in the pregnant baboon. Am J Obstet Gynecol. 1979;134(3):270-5.

Garg N, Vanitha VG. A randomized controlled trial of intravenous paracetamol and intravenous tramadol for labour analgesia. Obstetr Gynecol Res. 2019;2(2):003-13.

Das BP, Ali J, Baruah A. Comparative study between intravenous paracetamol and intramuscular tramadol as labour analgesic. Int J Sci Res. 2016;5(10):1675-9.

Elbohoty AE, Abd-Elrazek H, Abd-El-Gawad M, Salama F, El-Shorbagy M, Abd- ElMaeboud KH. Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor. Inter J Gynecol Obstetr. 2012;118(1):7-10.

Aimakhu CO, Saanu OO, Olayemi O. Pain relief in labor: A randomized controlled trial comparing intramuscular tramadol with intramuscular paracetamol at the University College Hospital, Ibadan, Nigeria. Trop J Obstetr Gynaecol. 2017;34(2):91-8.

Makkar JK, Jain K, Bhatia N, Jain V, Mithrawal SM. Comparison of analgesic efficacy of paracetamol and tramadol for pain relief in active labor. J Clin Anesth. 2015;27(2):159-63.

Long J, Yue Y. Patient controlled intravenous analgesia with tramadol for labour pain relief. Chin Medi J. 2003;116(11):1752-5.






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