Comparative Study of Intravenous Paracetamol Infusion versus Intramuscular Tramadol as an Intrapartum Labor Analgesia

Abstract

Context: Paracetamol exerts its analgesic effect by inhibiting prostaglandin synthesis in the central nervous system and peripheral action by blocking the generation of pain impulses. It has also a serotonergic (5Ht) mechanism and a cannabinoid agonist mechanism. Aims: We planned this study to compare intravenous and intramuscular tramadol as labor analgesia. Settings and Design: This prospective single-blinded randomized study was conducted in primigravida labor patients at tertiary care hospital between January 2016 and December 2018 after getting the permission of the ethical committee. Methods: Patients were randomly divided into two groups using a computer-generated random table in the Paracetamol group (Group A) and Tramadol group (Group B). Group A (60 patients) received IV PCM 1000 mg in the active phase of labor single dose over 15 min. Group B, received intramuscular tramadol hydrochloride 100 mg. Labor was monitored using partograph, pain intensity was recorded before, 1 h, and 3 h of drug administration using the Mac Gill pain intensity scale. Statistical Analysis Used: We did statistical analysis using IBM SPSS version 22.0 software. We used an independent t-test to analyze the difference in continuous dependent variables in two groups. The MacGill's pain intensity scale score was examined using repeated measures of analysis of variance for mean scores on 3 outcome measures: Before drug delivery, 1 h after drug delivery and 3 h after drug delivery. Results: Overall paracetamol was well tolerated as compared to tramadol. Patients who received paracetamol experienced fewer side effects including nausea and vomiting. The difference was statistically significant (Chi-square = 8.091; df = 2; P = 0.018). In the paracetamol group, 8 (15%) patients had nausea and 1 (2%) experienced vomiting; while in the tramadol group, 6 (11%) patients had nausea and 10 (19%) patients experienced vomiting. Conclusions: Paracetamol is safe labor analgesic as compared to intramuscular tramadol. Further studies consisting of a greater number of patients are needed to validate the results of this study.