Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia

Authors

  • Aman Choudhary Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Sakshi Maheshwari Department of Anaesthesia, Care Hospital, Musheerabad, Hyderabad, Telangana, India
  • Naveen Paliwal Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Shobha Ujwal Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Geeta Singariya Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20203684

Keywords:

Epidural labour analgesia, Fentanyl, Tramadol, Ropivacaine

Abstract

Background: Toxonomy committee of International Association defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. The present study was conducted to evaluate the effect of a combination of low dose ropivacaine with fentanyl and tramadol in epidural labour analgesia.

Methods: This prospective randomized double blinded clinical study was conducted in 100 patients in labour after ethical committee approval. Inclusion criteria was patients who had ASA I and ASA II (American society of anesthesiologists physical status classification system), age above 18 years, height more than 150 cm, weight less than 110 kg, either primigravidae or gravid 2. Patients were allocated into two groups Group F (ropivacaine with fentanyl) and group T (ropivacaine with tramadol) by computer generated randomisation technique.

Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 22.54±2.5, mean age in group T (ropivacaine with tramadol) was 22.86±2.17, and weight in group F was 56.68±2.75 and group T was 56.58±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (P>0.05). More side effects were seen in group F.

Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

Author Biographies

Aman Choudhary, Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India

Medical Officer, Department of Anaesthesia

Sakshi Maheshwari, Department of Anaesthesia, Care Hospital, Musheerabad, Hyderabad, Telangana, India

Consultant Anaesthesiologist

Naveen Paliwal, Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India

Associate Professor, Department of Anaesthesia

Shobha Ujwal, Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India

Senior Professor, Department of Anaesthesia

Geeta Singariya, Department of Anaesthesia, Dr. SN Medical College, Jodhpur, Rajasthan, India

Senior Professor, Department of Anaesthesia

References

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.

Soet JE, Brack GA, Dilorio C. Prevalence and predictors of women experience of psychological trauma during childbirth. Birth. 2003;30:36-46.

Holdcroft A. Regional anaesthetic techniques. Chapter-15. Principles and practice of obstetric anaesthesia and analgesia, Black Well Science Publishers. 2000;243-59.

Falconer AD, Powles AB. Plasma noradrenaline levels during labour-influence of elective lumbar epidural blockade. Anaesthesiol. 1982;37:16-8.

Marx GF, Greene NM. Maternal lactate, pyruvate and excess pyruvate production during labour and delivery. Am J Obstet Gynecol. 1964;90:786-9.

Dostbil A, Celik M, Alici HA, Erdem AF, Aksoy M, Ahiskalioglu A. Maternal and neonatal effects of adding morphine to low dose bupivacaine for epidural labour analgesia: Niger J Clin Prac. 2014;17(2):205-11.

Peng PWH, Sandler AN. A review of the use of fentanyl analgesia in the management of acute pain in adults. Anesthesiol. 1999;90(2):576-99.

Finegold, Mandell G, Ramanathan S. Comparison of ropivacaine 0.1% fentanyl and bupivacaine 0.125% fentanyl infusions for epidural labour analgesia. Can J Anaesth. 2000;47(8):740-5.

Rao ZA, Choudhri A, Naqvi S, Haq EU. Walking epidural with low dose bupivacaine plus tramadol on normal labour in primipara. J Coll Phys Surg Pak. 2010;20(5):295-8.

Gupta N, Gupta S, Agarwal A, Agarwal S, Dwivedi S, Singh A. To study the painless labour by epidural analgesia and its effects on cardiotocographic parameters and labour. Int J Reprod Contracept Obstet Gynecol. 2013;2(4):666-7.

Kalra S, Saraswat N, Agnihotri GS. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labour analgesia Saudi J Anaesth. 2010;4(3):178-81.

Tomar GS, Godwin RB, Gaur N, Sethi A, Narang N. A double blind study on analgesic effects of fentanyl combined with bupivacaine for extradural labour analgesia. Anaesthesia: Essays and Researches. 2011;5(2):147-52.

Fan Y, Ji M, Zang L, Wang W, Yin Q, Xu J, Yang J. Comparison of epidural tramadol ropivacaine and fentanyl ropivacaine for labour analgesia: a prospective randomized study. Upsala J Med Sci. 2011;116:252-7.

James KS, McGrady, Quasim J, Patrick. A comparison of epidural bolus administration of 0.25% bupivacaine and 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour. Br J Anaesth. 1998;81:501-10.

Saunders NJ, Spiby H, Gilbert L, Fraser RB. Oxytocin infusion during second stage of labour in primiparous women using epidural analgesia. BMJ. 1989;299(6713):1423-6.

Reynolds F, Sullivan GO. Epidural fentanyl and perineal pain in labour. Anaesth. 1989;44:341-4.

Chestnut DS, Laszewski LJ Pollack K, Bates JN, Manage NK, Choi DW. Continuous epidural infusion of 0.0625% bupivacaine+0.0002% fentanyl during second stage labour. Anaesthesiol. 1990;72:613-8.

Cohen SE, Tan S, Albright GA, Halpern J. Epidural fentanyl/bupivacaine mixture for obstetric analgesia. Anesth. 1987;67:403-7.

Downloads

Published

2020-08-26

How to Cite

Choudhary, A., Maheshwari, S., Paliwal, N., Ujwal, S., & Singariya, G. (2020). Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia. International Journal of Research in Medical Sciences, 8(9), 3309–3314. https://doi.org/10.18203/2320-6012.ijrms20203684

Issue

Section

Original Research Articles