Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine
Background: Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compar...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2014-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/4747/9131_CE(Ra)_F(Sh)_PF1(PAK)_PFA(AK).pdf |
| Summary: | Background: Feeling of pain is one of the most important
emotional determinants which dominate the perception of
females who undergo the process of labour and delivery. Patient
controlled epidural labour analgesia (PCEA) is convenient and
safer technique for this purpose. Very few studies compared
clonidine and fentanyl with ropivacaine in labour analgesia
in past. This study was undertaken to compare fentanyl and
clonidine in PCEA.
Aims: To compare low concentration ropivacaine with or
without fentanyl or clonidine for labour analgesia and its effect
on maternal and foetal safety.
Settings and Design: Prospective, double blind, randomized,
comparative study.
Materials and Methods: Ninety primegravida in labour were
divided into three groups (n=30) and patient controlled epidural
labour analgesia was given to them: Initial bolus of 10ml of
ropivacaine 0.125% in Group I; with fentanyl 2 µg/ml in Group
II and with clonidine 1µg/kg in Group III. Subsequently each
group received ropivacaine 0.125% through patient controlled
epidural analgesia (PCEA) as background infusion of 5 ml/hr
with lockout interval time of 10min and subsequent bolus of
5ml. Hemodynamic parameters, sensory level, motor block and
pain relief were noted. Total analgesic dose of local anaesthetic
and feto-maternal adverse effects were also recorded.
Results: At baseline, groups were matched demographically,
hemodynamically as well as for intensity of pain. There was a
statistically significant decrease in hemodynamic parameters
from baseline in all groups with maximum reduction in group
III. A significant difference among groups in VAS was observed
at zero min and from 120min till 240min intervals and lowest
values were in Group III. No significant difference was observed
among the groups for mode of delivery and expulsive efforts.
Total analgesic dose and PCA bolus requirement was maximum
in Group I and minimum in Group III and the difference was
statistically significant among groups. Six (20%) patients had
shivering in Group II and hypotension was recorded in only 1
(3.3%) patient of Group III.
Conclusion: Ropivacaine 0.125% was effective in decreasing
labour pain without any motor blockade. Clonidine 1µg/kg was
superior to fentanyl 2µg/ml as an adjuvant in PCEA for labour
without any significant feto-maternal adverse effects. |
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| ISSN: | 2249-782X 0973-709X |