Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

Abstract

Ropivacaine in epidural anaesthesia is known to cause less motor blockade and high maternal satisfaction. ABSTRACTBackground: The pain of childbirth is one of the most severe types of pain that a woman experiences in her lifetime. Adequate analgesia during labour has a positive influence on the course of labour. For labor analgesia several nonpharmacologic and pharmacologic methods are adopted. The objective of the study is to compare parenteral tramadol and epidural ropivacaine with regard to maternal and labour outcome. Methods: This prospective, comparative, interventional clinical study was conducted at Kasturba Hospital, Daryaganj, Delhi, on the patients admitted in the labour room of the hospital during the period of September 2014 to July 2015. Various parameters of maternal condition and labour outcome in each group were monitored and compared. These included the degree of pain relief and patient satisfaction, duration of 1 st and 2 nd stage of labour, mode of delivery and duration of third stage and any third stage complication like post-partum haemorrhage (PPH) and retained placenta and side effect profile of both the drugs. Results: Epidural ropivacaine has significantly better analgesic efficacy and faster onset of action as compared to I/M tramadol and patients in epidural group were significantly better satisfied. Ninety-two percent of patients in tramadol group and eighty eight percent in epidural group underwent normal delivery. Duration of the three stages of labour, complications of third stage and side effect profile in both the groups were comparable. Conclusions: Maternal outcome in labour analgesia is similar with 100 mg I/M tramadol and epidural ropivacaine. There is no significant difference between duration of labour, rate of LSCS, incidence of instrumental delivery and neonatal outcome in the two modes of analgesia. Analgesic efficacy with epidural ropivacaine seems to be better compared to intramuscular tramadol.

Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

“…Similar was the finding by previous authors. 6,9,10 The cervical dilatation at first dose of the intervention (i.e. initial cervical dilatation) was comparable between the two groups, and also corroborates with findings of previous study.…”

“…Of them, epidural analgesia is the most accepted method as it has been found to be both safe (both for the mother and the neonate), and effective. [3][4][5][6] However, there is some doubt regarding its effect on the duration of labour (some think that it may increase the rate of instrument application or operative delivery including caesarean section). 7,8 Ropivacaine is a local anaesthetic agent which produces less motor blockade and thus produces a higher patient satisfaction when used as an epidural anaesthetic agent with or without other agents.…”

“…7,8 Ropivacaine is a local anaesthetic agent which produces less motor blockade and thus produces a higher patient satisfaction when used as an epidural anaesthetic agent with or without other agents. 2,6 Tramadol is a potent opioid analgesic that blocks both nor-adrenergic and serotonergic receptor produces less/no maternal sedation and respiratory depression in the neonate. 2,6 It can be used via oral, intramuscular, intravenous and epidural routes with minimal side effects.…”

“…2,6 Tramadol is a potent opioid analgesic that blocks both nor-adrenergic and serotonergic receptor produces less/no maternal sedation and respiratory depression in the neonate. 2,6 It can be used via oral, intramuscular, intravenous and epidural routes with minimal side effects. Hence this study was designed to investigate the safety and efficacy of epidural analgesia using ropivacaine with fentanyl compared to intravenous tramadol in high risk labouring parturients.…”

“…The comparison is made with intravenous tramadol as use of tramadol for labour analgesia has been recommended. 2,6,9,10 …”