Comparison of butorphanol-drotaverine versus tramadol-drotaverine as labour analgesics: an observational comparative study

Zarnain Abid; Sumaira Yousuf; Farheen Qureshi; Syed Masuma Rizvi; Mohammad Ommid; Farha Qureshi; Ashfaq Masood

doi:10.18203/2320-1770.ijrcog20252336

Authors

Zarnain Abid Department of Obstetrics and Gynaecology GMC Srinagar, Jammu and Kashmir, India
Sumaira Yousuf Department of Obstetrics and Gynaecology GMC Srinagar, Jammu and Kashmir, India
Farheen Qureshi Department of Obstetrics and Gynaecology GMC Srinagar, Jammu and Kashmir, India
Syed Masuma Rizvi Department of Obstetrics and Gynaecology GMC Srinagar, Jammu and Kashmir, India
Mohammad Ommid Department of Anaesthesiology and Critical Care GMC Srinagar, Jammu and Kashmir, India
Farha Qureshi Department of Radiodiagnosis and Imaging GMC Srinagar, Jammu and Kashmir, India
Ashfaq Masood Department of Paediatrics and Neonatology GMC Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20252336

Keywords:

Butorphanol, Tramadol, Drotaverine, Labor analgesia, Pain relief, Maternal outcomes, Fetal outcomes

Abstract

Background: Labour pain is a significant challenge in obstetric care, with effective pain management being essential for maternal well-being and labor outcomes. Epidural analgesia, the gold standard, is often inaccessible in resource-limited settings. Parenteral opioids like butorphanol and tramadol, combined with drotaverine, may provide an effective, low-cost alternative. To compare the effectiveness of butorphanol-drotaverine versus tramadol-drotaverine as labour analgesics in terms of maternal pain relief, labour outcomes and fetal outcomes.

Methods: This observational, prospective, single-center study was done on 300 low-risk primigravid women in active labor where Butorphanol 1 mg+Drotaverine 40 mg was given to 150 patients (Group B) and Tramadol 100 mg+Drotaverine 40 mg was given to another 150 patients (Group T). Maternal pain was assessed using the Visual Analog Scale (VAS) at various time intervals. Labor progress, mode of delivery and side effects were monitored, along with fetal outcomes including Apgar scores and NICU admissions.

Results: Both analgesic combinations provided effective pain relief, with Butorphanol providing quicker pain relief while as more sustained pain reduction was obtained with Tramadol. However, there were no significant differences in labor duration, mode of delivery or neonatal outcomes. Nausea was more common in the Tramadol group. Both drugs were well-tolerated, with minimal adverse effects.

Conclusions: Both Butorphanol and Tramadol are effective for labor analgesia, with Butorphanol providing faster pain relief. These opioids offer a cost-effective alternative to epidural analgesia, especially in resource-limited settings, ensuring access to pain relief for all women during labor.

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References

Rudra A. Article 3: 1 of 2 Update in Anesthesia. 2004: 18. DOI: https://doi.org/10.1053/S1053-0770(04)00090-4

Clark V, Van de Velde M, Fernando R, editors. Oxford textbook of obstetric anaesthesia. Oxford University Press. 2016. DOI: https://doi.org/10.1093/med/9780198713333.001.0001

Melzack R. The Myth of painless childbirth. Pain. 1984;19:321-37. DOI: https://doi.org/10.1016/0304-3959(84)90079-4

Hiltunen P, Raudaskoski T, Ebeling H, Moilanen I. Does pain relief during delivery decrease the risk of postnatal depression. Acta Obstet Gynecol Scand. 2004;83:257-61. DOI: https://doi.org/10.1111/j.0001-6349.2004.0302.x

Christiansen P, Klostergaard KM, Terp MR, Poulsen C, Agger AO, Rasmussen KL. Long memory of labor pain. Ugeskr Laeger. 2002;164(42):4927-29.

Niven C, Gijsbers K. Obstetric and non-obstetric factors related to labour pain. J Reprod Infant Psychol. 1984;1;2(2):61-78. DOI: https://doi.org/10.1080/02646838408403451

Jamwal S, Manhas A, Gupta S, Nafae P. Relief of Labour Pain with Single Dose of Tramadol Hydrochloride. Int J Med Res Prof. 2017;3(3):223-32.

Maduska AL, Hajghassemali M. A double-blind comparison of butorphanol and meperidine in labour: maternal pain relief and effect on the newborn. Can Anaesth Soc J. 1978;25(5):398-404. DOI: https://doi.org/10.1007/BF03006569

Atkinson BD, Truitt LJ, Rayburn WF, Turnbull GL, Christensen HD, Wlodaver A. Double-blind comparison of intravenous butorphanol (Stadol) and fentanyl (Sublimaze) for analgesia during labor. Am J Obstet Gynecol. 1994;171(4): 993-8. DOI: https://doi.org/10.1016/0002-9378(94)90021-3

Halder A, Agarwal R. Butorphanol in labour analgesia: A prospective cohort study. J Turk Ger Gynecol Assoc. 2013;14(4):221-4. DOI: https://doi.org/10.5152/jtgga.2013.13549

Ahluwalia P, Rehman F, Ahluwalia A. Comparison of butorphanol tartrate and tramadol hydrochloride for postoperative pain relief following abdominal surgery: a prospective, randomized, double-blind study. Int J Sci Stud. 2015;3(9):120-4.

Srivastava K, Sinha P, Sharma R, Gupta U. A comparative study of the effect of drotaverine hydrochloride with hyoscine butylbromide in first stage of labor. Int J Basic Clin Pharmacol. 2015;4(3):488-91. DOI: https://doi.org/10.18203/2319-2003.ijbcp20150025

Tripti N, Jyoti J. To compare and evaluate the efficacy and safety of drotaverine and valethamate bromide. J Obstet Gynecol. 2009;59(4):324-1.

Khooshideh M, Shahriari A. A comparison of tramadol and pethidine analgesia on the duration of labour: a randomised clinical trial. Aust N Z J Obstet Gynaecol. 2009;49(1):59-63. DOI: https://doi.org/10.1111/j.1479-828X.2009.00949.x

Bajaj P, Meena R, Prasad R. Intravenous tramadol for labour analgesia. Indian Pract. 1997;50:1051-4.

Kuti O, Faponle AF, Adeyemi AB, Owolabi AT. Pain Relief in labour: A randomized controlled trial comparing pentazocine with Tramadol. Nepal J Obst Gynaecol. 2008;3(1):14-8. DOI: https://doi.org/10.3126/njog.v3i1.1433

Thakur R, Patidar R. Comparative study of transcutaneous electrical nerve stimulation (TENS) and tramadol hydrochloride for pain relief in labor. J Obstet Gynecol India. 2004;54:346-50.

Lakshman TK, Lakshman K. A study to compare the maternal and fetal effects with the use of tramadol as an analgesic during labour. International J Clin Obst Gynaecol. 2019;3(6):276-9. DOI: https://doi.org/10.33545/gynae.2019.v3.i6e.425

Lallar M, Anam HU, Nandal R, Singh SP, Katyal S. Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labor analgesic. J Obstet Gynaecol India. 2015;65(1):17-22. DOI: https://doi.org/10.1007/s13224-014-0556-x

Andey AK, Aleenasibi, Ullagantisaichaitanya, Mohanta GP. Sangeereni M. Study on Use of Intramuscular Tramadol as Analgesic during Labour. J Pharm Biol Sci. 2018;13(4):73-9.