Outcome of labor with epidural analgesia in primigravida at term
Keywords:Epidural analgesia, Labour analgesia, Opiods, Tramadol
Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look into the effects of labour analgesia on maternal and fetal outcomes and compare the same with that of opioid analgesics.
Methods: It was a prospective randomized controlled trial on 100 patients where parturients were randomly allocated to either group 1-( n=50 patients) who received epidural analgesia or group 2 (n=50) who received intramuscular tramadol. The two groups were compared for duration of labour, analgesic efficacy as assessed by using Visual Analogue Scale (VAS) ,type of delivery – normal/instrumental/operative interventions ,1 and 5 min neonatal Apgar score and neonatal breast-feeding behavior between the two groups.
Results: Epidural analgesic gave better pain relief than tramadol which was found to be stastically significant (p<0.001) on comparing the VAS scores and also gave statistically significantly higher satisfaction levels. Duration of both first and second stage of labor was comparable between the two groups and instrumental deliveries and caesarean sections were also comparable to that in tramadol group. There was a trend of higher neonatal Apgar scores in the epidural group than in the tramadol group.
Conclusions: Use of effective analgesia in labour, does not prolong second stage of labor and may facilitate good labour outcome both for the mother and the fetus and should be offered to patients in tertiary setups and equipped centres when the patients are apprehensive about labor pains.
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