Ambika¹, Lalit Mohan Negi², Priyanshu Sharma^3*, Jassa Ram⁴, Kamlesh Chaudhary⁵

¹Department of Health and Family Welfare HP Government, Operation Theatre Incharge Deen Dyal Upadhyay Zonal Hospital Shimla, District Shimla Himachal Pradesh, INDIA.

²Senior Resident Department of OBG, IGMC, Shimla, INDIA.

³Department of Health and Family Welfare Hp Government, Operation Theatre Incharge Civil Hospital Theog, District Shimla Himachal Pradesh, INDIA.

⁴senior Resident Department of Anaesthesia Slbsmc Nerchok District Mandi HP, INDIA.

Email: priyanshusharma27@gmail.com

Table 1: General characteristics

In BF group early onset of labor analgesia, more duration of labor analgesia, better rate of cervical dilatation, APFAR scores and less duration of second stage was noted as compared to group F, difference was not significant. While short duration of active first stage was noted in group F than group BF, difference was not significant. No side effects/ adverse effects were noted in present study.

Table 2: Labor characteristics

DISCUSSION

Painful uterine contractions cause maternal hyperventilation and increased catecholamine concentration resulting in maternal and fetal hypoxaemia.⁵ An ideal labour analgesic technique should provide adequate and satisfactory analgesia without any motor blockade or adverse maternal and fetal effects. Among the variety of labour analgesia techniques ranging from parenteral and inhalational agents, regional analgesia has an edge over other methods in achieving the above goals.² Fentanyl has been studied extensively and is added during induction of anesthesia to provide analgesia during surgical procedures and to decrease the hypertensive response to intubation.⁶ Often, intrathecal opioids, such as fentanyl or sufentanil, are combined with local anesthetics, thereby markedly enhancing the quality and duration of postoperative analgesia after cesarean delivery as well as providing better parturient comfort without affecting neonatal outcome significantly.⁷ Bupivacaine is the most commonly used drug for subarachnoid block due to its lesser side effects. Various studies have shown that low‑dose diluted bupivacaine with fentanyl can provide sufficient anesthesia with rapid recovery in patients undergoing ambulatory surgery or minor urological surgeries.⁸ In study by Gowrisree K, ⁹ duration of the active phase of first stage of labor was slightly shortened in group A (intrathecal labor analgesia with fentanyl 25 μg) as compared to group B (fentanyl 20 μg plus bupivacaine 2.5 mg). Duration of the second stage of labor was slightly prolonged in group-B as compared to group A (22.2 vs 25.07min,) and significant. Rate of cervical dilation was faster in group A as compared to group B (1.93 vs. 1.94 cm/h). They concluded that, rapid onset with satisfactory pain relief, VAS scores <4 and good maternal and fetal hemodynamics in both the groups and minimal motor block in group-B. Similar findings were noted in present study. Mathur P et al.,¹⁰ noted that, mean duration of second stage of labor was significantly prolonged in labour analgesia group (18.03 ± 8.27 min) as compared to control group (10.13 ± 5.89 min) and difference was statistically significant (P < 0.001). Possible reason for a prolonged second stage could be relaxation of the abdominal wall musculature secondary to neuraxial local anesthetic resulting in decreased effectiveness of maternal expulsive efforts. Mathur P et al. concluded that single shot intrathecal analgesia using fentanyl 25 μg and bupivacaine 2.5 mg when given in the active phase of first stage of labor had rapid onset with satisfactory pain relief and minimal motor block, associated with faster cervical dilation rate and no delay in the progress of labor, without significant maternal and fetal hemodynamic variation. Fentanyl has been used along with bupivacaine for labor analgesia extensively to decrease motor block, however the addition of opioids to local anesthetics has disadvantages of pruritus and respiratory depression.¹¹ No side effects/ adverse effects were noted in present study. Traditional epidural techniques, employing high concentrations of local anaesthetic (at least 0.25% bupivacaine), have been associated with prolonged labour, use of oxytocin augmentation and an increased incidence of instrumental vaginal delivery.² Higher doses of bupivacaine, increasing the level of blockade are likely to enhance hypotension and induce breathing difficulties but reducing the dose of bupivacaine does not prevent hypotension.¹² Also coadministration of small doses of intrathecal opioids with bupivacaine for spinal anaesthesia is advisable and advantageous in order to decrease the intensity as well as severity of spinal complications associated with spinal anaesthesia.¹³ Combined Spinal Epidural technique provides effective and timely labour analgesia particularly for women in active labour. CSE technique consists of a spinal injection of a small dose of local anaesthetics and/or lipophilic opioids (usually Fentanyl or Sufentanil), followed by introduction of catheter into epidural space for maintaining of analgesia by extradural drug administration.¹⁴

CONCLUSION

Intrathecal fentanyl with bupivacaine group had early onset of labor analgesia, more duration of labor analgesia, better rate of cervical dilatation, APFAR scores and less duration of second stage. Though no significant difference was noted for duration of active phase of first stage, duration of second stage and progress of labour in both groups.

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