Comparative Study on the Efficacy of Two Regimens of Single-Shot Spinal Block for Pain Relief in Women Presenting in Established Labour

Published on Jan 1, 2013in East African Medical Journal
· DOI :10.4314/EAMJ.V90I1
P N Tshibuyl1
Estimated H-index: 1
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P Olang1
Estimated H-index: 1
+ 1 AuthorsT Chokwe7
Estimated H-index: 7
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Abstract
Background : Most women experience moderate to severe pain during  labour and delivery, often requiring some form of pharmacologic  analgesia. The lack of proper psychological preparation combined with fear and anxiety can greatly enhance the patientfs sensitivity to pain and further add to the discomfort. Skillfully conducted obstetric analgesia, in addition to relieving pain and anxiety, may benefit the mother by increasing self esteem and improving bonding with the baby. Objective : To assess and compare the satisfaction and efficacy of two regimens of single-shot spinal blocks for the relief of labor pain in women who present in active phase of labour. Design : A prospective randomised single-blind observational study Setting : Labour ward of Kenyatta National Hospital, Nairobi. Subjects : All consenting primiparous women presenting in active phase of labor with uncomplicated singleton pregnancy at term (> 37 weeks) and in cephalic presentation, who reported a > 70 mm VAS (Visual Analog Scale) pain score at cervical dilatation . 5 cm at the time of request for labour analgesia. Results : Effective labour analgesia lasting up to 120 minutes was observed in the fentanyl-bupivacaine group but with a high incidence of  breakthrough pain. The fentanyl-bupivacaine-morphine group had labour analgesia lasting up to 180 minutes or even more with a lower incidence of breakthrough pain. The one-minute and fiveminute Apgar scores in the morphine group were significantly lower (p = 0.026 and 0.044 respectively) than in the fentanyl group but the difference in neonatal outcome had no clinical significance, and there were no significant differences in adverse effects, sensory levels, and motor power between the two groups.: Conclusion Effective analgesia for about 120 minutes was observed in the fentanylbupivacaine group with high incidence of breakthrough pain while the fentanylbupivacaine-morphine group had labour analgesia prolonged up to more than three hours. The difference in fetal outcome had no clinical significance for the morphine group, and there were no significant differences in adverse effect, sensory levels, and motor power between the two groups. These findings show that intrathecal analgesia is safe and the use of the combination of fentanyl-bupivacaine-morphine gives adequate and safe analgesia during labour and delivery.
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2013
1 Author (V S Vaishnavi)
References13
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#1Ruth LandauH-Index: 30
#2C. KernH-Index: 12
Last. Jean-Louis BlouinH-Index: 44
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Labor initiates one of the most intensely painful episodes in a woman's life. Opioids are used to provide analgesia with substantial interindividual variability in efficacy. mu-Opioid receptor (muOR, OPRM1) genetic variants may explain differences in response to opioid analgesia. We hypothesized that OPRM1 304A/G polymorphism influences the median effective dose (ED(50)) of intrathecal fentanyl via combined spinal-epidural for labor analgesia. Nulliparous women were prospectively recruited aroun...
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#1Krzysztof M. Kuczkowski (UCSD: University of California, San Diego)H-Index: 20
#2Susilo Chandra (UI: University of Indonesia)H-Index: 7
The purpose of this study was to assess maternal satisfaction with single-dose spinal analgesia for the management of obstetric pain in Indonesian women. The investigation included 62 laboring women with single pregnancy at term, with 45 primigravidas and 17 multigravidas. The participants’ ages ranged from 15 to 29 years. All participants were screened for physical health and were classified as healthy according to the American Society of Anesthesiologists classification system. All 62 parturie...
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#1Robert Minty (Northern Ontario School of Medicine)H-Index: 4
#2Len KellyH-Index: 18
Last. D.C. HammettH-Index: 1
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OBJECTIVE To examine the safety and efficacy of single-dose spinal analgesia (intrathecal narcotics [ITN]) during labour. QUALITY OF EVIDENCE MEDLINE was searched and the references of 2 systematic reviews and a meta-analysis were reviewed to find articles on obstetric analgesia and pain measurement. The 33 articles selected included 14 studies, 1 meta-analysis, and 2 systematic reviews, all providing level I evidence. MAIN MESSAGE The literature supports use of ITN as a safe and effective alter...
#1O. KutiH-Index: 1
#2A. F. Faponle (OAU: Obafemi Awolowo University)H-Index: 1
SummaryIn Nigeria, it is generally assumed that labour is well tolerated and pain relief is not usually considered an important part of intra-partum care. This prospective study was carried out to assess mothers' perception of labour pain and determine any factor that may influence it. During the period of study, 281 women who delivered at Wesley Guild Hospital Ilesa, Nigeria were interviewed within 2 h of delivery to assess the severity of labour pain and desire for analgesia. Perception of lab...
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#1H. ViitanenH-Index: 2
#2M. ViitanenH-Index: 2
Last. M. HeikkiläH-Index: 2
view all 3 authors...
Background: Intrathecal analgesia (ITA) is effective in late, rapidly progressing labour. In 1998, our hospital implemented the use of single-shot spinal block for pain relief in multiparous parturients. As part of a quality assurance programme, we assessed the analgesic efficacy, obstetric and neonatal outcomes and maternal satisfaction after this form of analgesia now in routine use in our labour ward. Methods: Two hundred and twenty-nine consecutive multiparous parturients presenting for vagi...
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#1Oladapo Olayemi (University College Hospital, Ibadan)H-Index: 21
#2R A Adeniji (University College Hospital, Ibadan)H-Index: 2
Last. K A Shoretire (University College Hospital, Ibadan)H-Index: 2
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This cross-sectional study of one thousand parturients aims to evaluate the factors, which are associated with pain perception in labour and to identify women who will benefit most from analgesia in labour. The instrument applied was a structured questionnaire incorporating the Box numerical scale (BNS) for pain assessment. Patients who delivered by elective or emergency caesarean section and women who did not give informed consent were excluded from the study. Spearman's and Pearson's correlati...
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#1Philip E. Hess (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 21
#2A. VasudevanH-Index: 5
Last. Stephen D. PrattH-Index: 17
view all 4 authors...
We investigated the duration of labor analgesia produced by a small dose of spinal bupivacaine/fentanyl alone or in combination with a small dose of morphine. Sixty parturients were enrolled in this placebo-controlled, double-blinded, randomized trial. All women received a spinal injection of 12.5 μg of fentanyl with 2 mg of bupivacaine. The morphine group (MBF) also received 125 μg of morphine; the placebo group (BF) received saline. Pain scores were <3 of 10 within 10 min of injection. The med...
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#1N. G. LeslieH-Index: 1
The purpose of the study was to characterize parturients who prefer to deliver without the use of analgesia. The study population consisted of 446 consecutive low risk laboring women in early active stage of labor. Data were collected prospectively by an obstetrician, using a structured questionnaire. The degree of pain was assessed by using a visual analog scale (VAS). An obstetrician and a midwife together estimated the degree of pain as was exhibited by the parturients, using the same scale. ...
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#1Christopher M. Viscomi (UofU: University of Utah)H-Index: 14
#2James P. RathmellH-Index: 47
Last. Nathan L. PaceH-Index: 62
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Early first-stage labor pain is primarily visceral in origin. Increasing pain intensity and transition to somatic nociceptive input characterizes late first- and second-stage labor pain. The effect of this change in nociceptive input on the duration of intrathecal labor analgesia has not been well studied. This prospective cohort observational study compares the duration of intrathecal labor analgesia after intrathecal injections made in early labor (3- to 5-cm cervical dilation) and those made ...
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Cited By1
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#1Gian Chauhan (IGMC: Indira Gandhi Medical College)H-Index: 1
#2Poonam Samyal (IGMC: Indira Gandhi Medical College)H-Index: 1
Last. Anshit Abhi Pathania (IGMC: Indira Gandhi Medical College)H-Index: 1
view all 3 authors...
Epidural analgesia is often said the gold standard of the labor analgesia. But in the areas where the availability of epidural catheters, multiparameter monitors, trained staff is scarce, we need to rethink for single-dose intrathecal analgesia as an alternate yet effective method to provide labor analgesia. The combination we chose for single-shot spinal was heavy bupivacaine 2.5 mg + fentanyl 25 μg + morphine 250 μg, so as to provide an optimal time period of analgesia and lesser need for supp...
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