Aim of the study: To evaluate the analgesic efficacy of low dose Intrathecal labour analgesia using fentanyl, bupivacaine and morphine.

Methodology: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1(N=50) received intrathecal labor analgesia using. fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg)  and Group 2(N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia. Duration of analgesia, Visual analog scale score (VAS) and effect on ambulation (EOA) were recorded.

Result: All the parturients were assessed on the basis of VAS score on a scale of 0 to 10. One min after administration of labor analgesia, the mean VAS score in group 1(6.74±0.527) was significantly lower when compared with the mean VAS score in group2 (7.74±0.853) (p value = 0.000). The significant difference continued till 300 minutes. The mean duration of labor analgesia in group1 (238.96 ±21.888 min) was significantly more than the mean duration of analgesia in group 2 (98.4±23.505 min). In group 1 significantly more number of parturients had mild EOA till 25 min (P value 0.035). The mild EOA disappeared by 30 min and subsequently no EOA was observed in parturients receiving intrathecal analgesia.

Conclusion: Single shot intrathecal labor analgesia is a safe, effective, reliable, cheap and satisfactory method of pain relief during labor and delivery.

Keywords: Labor analgesia, Intrathecal labor analgesia, Visual analog scale (VAS) score, Effect on ambulation (EOA), Rescue analgesia, Maternal satisfaction.

1. Westgren M, Lindahl SGE, Norden NE. Maternal and fetal endocrine stress response at vaginal delivery with and without an epidural block. Journal Perinatal Medicine. 1986;235-41.
2. Fyneface-Ogan S, Gogo Job O, Enyindah CE.Comparative Effects of Single Shot Intrathecal Bupivacaine with Dexmedetomidine and Bupivacaine with Fentanyl on Labor Outcome. ISRN Anesthesiology. 2012.
3. Westgren M, Lindahl SGE, Norden NE. Maternal and fetal endocrine stress response at vaginal delivery with and without an epidural block. Journal Perinatal Medicine. 1986;235-41.
4. Owen MD, Ozsarac O, Sahin S, Uckunkaya N, Kaplan N, Magunaci I. Low-dose Clonidine and Neostigmine Prolong the Duration of Intrathecal Bapivacaine- Fentanyl for Labor Analgesia. American society of anaesthesiologists. 2000;92(2):361-6.
5. Dostbil A, Celik M, Alici HA, Erdem1 AF, Aksoy M, Ahiskalioglu A. Maternal and neonatal effects of adding morphine to low-dose bupivacaine for epidural labor analgesia. Nigerian Journal of Clinical Practice. 2014;17(2):205-10.
6. Nelson KE, Rauch T, Terebuh V, D’Angelo R. A Comparison of Intrathecal Fentanyl and Sufentanil for Labor Analgesia. American Society of Anesthesiologists.2002;96:1070-3.
7. Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. American Journal of Obstetrics and Gynecology. 2002; 186(5): 94-109.
8. Viitanen H, Viitanen M, Heikkila M. Single-shot spinal block for labour analgesia in multiparous parturients. Acta Anaesthesiologica Scandinavica. 2005;49 (7):1023-9.
9. Mathur P, Jain N, Prajapat L, Jain K, Garg D, Khandelwal V. Effect of intrathecal analgesia using fentanyl and bupivacaine on progress of labor. J Obstet Anaesth Crit Care.2018;7:47-51.
10. Yeh HM, Chen LK, Shyu MK, Lin CJ, Sun WZ, Wang MJ et al. The addition of morphine prolongs fentanyl-bupivacaine spinal analgesia for the relief of labor pain. Anaesth Analg. 2001; 92: 665 – 8.
11. Hess PE, Vasudevan A, Snowman C, Pratt SD. Small dose bupviacaine-fentanyl spinal analgesia combined with morphine for labor. Anaesth Analg. 2003;97:247-52.
12. Tshibuyi PN, Olang POR, Ogutu O, Chokwe TM.A Comparative study on the efficacy of two regimens of single-shot spinal block for pain relief in women presenting in established labour. East African Medical Journal. 2013;90:12-8.
13. Bilge A, Müge A, Ahmet G, Burcu KK, Özlem M. Comparison of Different Bupivacaine and Fentanyl Combinations When Used with A Single Shot Spinal Block for Labor Analgesia. Journal of Anesthesia & ClinicalResearch. 2017;7(8):1-3.
14. Anabah T, Olufolabi A, Boyd J, George R. Low-dose spinal Anaesthesia provides effective labour analgesia and does not limit ambulation. Southern African Journal of Anaesthesia and Analgesia. 2015;21(1):19-22.
15. Kuczkowski KM, Chandra S. Maternal satisfaction with single-dose spinal analgesia for labor pain in Indonesia: a landmark study. Journal of Anesthesia. 2008;22(1):55–8.

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