Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour

Loughnan, B.A.; Carli, Franco; Romney, M.; Doré, Caroline J; Gordon, H.

doi:10.1093/oxfordjournals.bja.a013580

Cited by 74 publications

(33 citation statements)

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“…5 Despite providing excellent pain relief in labour, epidural analgesia using local anaesthetics alone produces motor block in up to 85% of patients, reduces maternal satisfaction with analgesia and is associated with a prolonged second stage and an increased incidence of instrumental delivery. 6 In an attempt to reduce the adverse effects of high concentrations of bupivacaine, adjuvants like fentanyl were added so as to decrease the maintenance concentration of bupivacaine from 0.5% to as low as 0.0625%. Workers using 0.0625% bupivacaine have noticed:…”

Section: Discussionmentioning

confidence: 99%

A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

Kanna¹,

Hakkim²,

Murugadoss³

et al. 2015

Int J Res Med Sci

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INTRODUCTIONPain in labour is an extremely agonising experience for most women. Various methods have been tried since time immemorial to alleviate this pain. However, this endeavor did not receive much support till the late 19th century, with analgesia for labour being opposed for both medical and religious reasons. It was also believed that ABSTRACT Background: Pain in labour is an extremely agonising experience for most women. Unrelieved labour pain produces many physiological changes which are detrimental to both the mother and the foetus. Various methods have been used to alleviate this pain. It is now well recognized that the only consistently effective method of pain in labour is lumbar epidural analgesia. Using a higher concentration of local anaesthetic agent to produce analgesia can be associated with undesirable side effects such as motor block, haemodynamic disturbances or interference with the progress of labour. Hence, various adjutants like adrenaline, clonidine and particularly opioids have been used to reduce the amount of local anaesthetics used and yet provide satisfactory analgesia. In view of the above, the present study assesses the clinical effectiveness of continuous lumbar epidural analgesia for vaginal delivery by using 0.0625% bupivacaine with 2µg/ml of fentanyl. Methods: Forty parturient admitted to Chennai Medical College and Hospital, Trichy, for vaginal delivery and who were in active labor was given 8 ml of 0.0625% bupivacaine with 2µg/ml of fentanyl. The parturient were assessed with respect to onset and duration of analgesia, maximum level of analgesia, pain scores, homodynamic parameters, motor block, side effects, mode of delivery and neonatal outcome. Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes). A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 µg of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate.

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Section: Discussionmentioning

confidence: 99%

A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

Kanna¹,

Hakkim²,

Murugadoss³

et al. 2015

Int J Res Med Sci

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“…[23][24][25][26][27][28][29] The number of participants who were given 50 mg of pethidine was 437, representing $ 26% of the total; this reflects the preference for researches employing more than 50 mg of pethidine, especially before 2006. Ideally, we need a study comparing pethidine at 2 doses: 50 mg and > 50 mg, with the same number of participants in each group.…”

Section: Discussionmentioning

confidence: 99%

Is Pethidine Safe during Labor? Systematic Review

Nunes

Colares

Montenegro

2017

Rev Bras Ginecol Obstet

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Purpose To verify if pethidine is safe for the conceptus when used during labor. Methods Systematic review in the Capes Periodicals/PubMed and MEDLINE/Virtual Health Library (BVS, in the Portuguese acronym) databases. Results A total of 17 studies published from January 1st, 2000, to September 2nd, 2016, with a total of 1,688 participants involved were included in the present review. There was no record of conceptus vitality decrease associated with low doses of pethidine being administered to mothers during labor. Conclusions Intramuscular (IM) or intravenous (IV) pethidine at low doses, of up to 50 mg, is safe to administer during labor.

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“…These permitted elective forceps delivery or assisted vaginal delivery for training purposes and had to be excluded from analysis of risk of instrumental vaginal delivery. 23 24 Even then there was a clinically important increase Bofill et al 1997 23 Clark et al 1998 24 Dickinson et al 2002 27 Loughnan et al 2000 25 Sharma et al 1997 20 Sharma et al 2002 26 Thorp et al 1993 22 Random combined Another limitation was the large number of women who changed to epidural analgesia despite being randomised to parenteral opioids. Our intention to treat approach would likely render any estimation of the effects of epidural analgesia more conservative, but it was necessary to prevent selection bias.…”

Section: Discussionmentioning

confidence: 99%

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

2004

Obstetrics & Gynecology

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Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. Study selection Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. Data synthesis Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). Conclusions Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.

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Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour

Cited by 74 publications

References 0 publications

A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

Is Pethidine Safe during Labor? Systematic Review

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

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