EVALUATION OF INTRATHECAL DEXMEDETOMIDINE ADDED TO BUPIVACAINE FOR LABOR ANALGESIA

Abstract

Background And Aims: The aim of this study was to evaluate the effectiveness of intrathecal dexmedetomidine with bupivacaine for labor analgesia by assessment of onset, duration and quality of analgesia and neonatal outcomes. Method: In this study 40 eligible parturient who received dexmedetomidine 5 g and heavy bupivacaine 0.5% 2.5 mg diluted upto 2.5 cc with sterile NS intrathecally for labor analgesia were selected. The time of onset, duration and quality of analgesia were noted. Maternal parameters pulse rate, systolic blood pressure, motor block and side effects of pruritus, nausea, vomiting, hypotension and headache were recorded. Neonatal outcomes in terms of mode of delivery and APGAR score were noted. If VAS >3, analgesia was supplemented with epidural bupivacaine 0.125% 10 ml during labor. For rescue analgesia, Inj. Tramadol 1 – 2 mg/kg iv was given as per institutional protocol if the patient VAS score was still more than 3 even after second dose of epidural. Result: Mean time for onset of analgesia was 2 minutes (VAS<3). All parturient had VAS < 3 throughout the labor. Mean duration of Labor was 99.4 ± 48.35 min. Total duration of labor ranges from 45 minutes to 210 minutes in our study. Most 92.5% of parturient had maximum motor blockade of grade 1 and it was lasted maximum upto 30 min. Hypotension was observed in two parturient and one parturient had nausea, which responded to conservative management. The mean APGAR score at 1 min was 8.85 ± 0.97 and at 5 min it was 10 (excluding LSCS delivery). Out of 40 total, 30 parturient have graded labor analgesia as excellent and rest have graded as good. Conclusion: Dexmedetomidine (5μg) seems to be a safe and efcacious adjuvant to intrathecal bupivacaine 0.5% (2.5 mg) in women undergoing vaginal delivery. This may be helpful for parturient coming late to the delivery room, seeking rapid onset with good quality of analgesia