English

Abstract

OBJECTIVES: The present study was planned as a prospective study with the following objectives: 1. To evaluate the efficacy of 0.125% bupivacaine with 20 µg fentanyl in relieving parturition pain with lumbar epidural and combined spinal epidural analgesia. 2. To compare the impact of lumbar epidural and combined spinal epidural technique on maternal satisfaction for pain relief, progress of labor, mode of delivery, neonatal outcome. RESULTS: The two groups were similar with respect to age distribution, height, weight, BMI of the parturients (table 1 & 2). The onset of analgesia was 1.98±0.33 min in group CSE and 5.00±1.64 min in group E (table 3). Peak action of analgesia was 4.15±0.41min in CSE group and 9.87±1.97 min in group E. The onset and peak of analgesia was faster in group CSE and is statistically significant with p<0.001 (table 4). VAS score was statistically similar in both groups (table 5). Motor blockade assessed by modified Bromage scale, there was no motor blockade in any case in either of the groups (table 6). In group CSE the pulse rate changed from basal 82.27±9.7 of beats per minute to 81.5±9.75 during first stage and 86.83±8.92 during the second stage. In group E the pulse rate changed from basal 81.53±7.43 of beats per minute to 83.67±8.65 during first stage and 87.73±10.02 during the second stage. This was comparable in both the groups and is statistically insignificant (table 7). The variations in blood pressure noted in SBP in 1st and 2nd stage were not statistically significant in both the groups (table 8). The variations noted in DBP were statistically significant in both groups. Parturients in group CSE had a basal DBP of 76mmhg which dropped to 73mmhg in first stage and 72mmhg in 2 nd stage. In epidural group basal DBP was 78mmhg which dropped to 76.6mmhg in the 1 st stage. In 3 rd stage mean DBP was 78mmhg which was similar to the basal DBP. The basal DBP was significantly less in 2 nd stage in CSE group compared to group E with respect to basal levels. This is statistically significant with p =0.001 (table 9). Mean cervical dilatation in group CSE was 3.93±0.58 cm and 3.86±0.57cm in group E which was statistically similar in both the groups (table 10). Mean duration of labor were not statistically significant for 1 st and 2 nd stages in the two groups. Duration of third stage was more in epidural group compared with CSE group and this was statistically significant (table 11). 63.3% of parturients in both the groups required only 1-2 top ups which was given on demand or when patient perceived pain .No top up was given in 16.7% and 10% parturients in group CSE and E respectively. Maximum top ups given was 5-6 for three parturients in CSE group and none in other group. Mean top up needed in CSE group was 1.70±1.46 and 1.67±0.99 in group E which was statistically insignificant (table 12). Mean interval between the time of analgesia and the time of delivery is 3.53±1.62 hrs. in group CSE and 3.48±1.18 hrs. in group E showing no statistical significance (table 13). CONCLUSION: We conclude that, the analgesia provided during labor by both the techniques was satisfactory and comparable. The onset and peak of analgesia was faster in CSE than epidural analgesia. The quality and duration of analgesia were comparable in both the groups. The drop in DBP in 2nd stage of labor