Combination of epidural bupivacaine and fentanyl for labour analgesia: An observational longitudnal study

Abstract

Labour is a physiological process which is associated with most severe pain. Goal of labour analgesia should be to ensure painless labour without any side effect. Various methods have been used to alleviate pain during labour but the only consistently effective method is lumbar epidural analgesia. Since higher doses of local anaesthetics cause undesirable effects like motor block and hemodynamic changes, adjuvants like opioids are used.The present study evaluates the clinical effectiveness of continuous lumbar epidural for vaginal delivery using 0.0625% bupivacaine with 2.5 mcg/ml of fentanyl. 91 patients admitted to Lalladed hospital govt medical college Srinagar for vaginal delivery and who were in active labour were given first loading dose of 10ml 0.25% plain bupivacaine via epidural catheter followed by continuous epidural infusion of 0.0625% bupivacaine with 2.5 mcg/ml fentanyl @ 12ml/hr. the parturients were assessed for onset and duration of analgesia, hemodynamics, sensory block, mode of delivery, and APGAR(neonatal outcome). Onset of analgesia was significantly faster(10 min). The duration of analgesia was also longer. There were no significant hemodynamic changes. No motor block was seen. 1 min and 5 min APGAR scores were comparable. It was concluded that epidural labour analgesia with low dose bupivacaine (0.0625%) with fentanyl (2.5mcg/ml) given through continuous infusion technique provides good pain relief to the parturient in labour with increased maternal satisfaction without significant maternal or fetal side effects.