Comparison of programmed vs. epidural labor analgesia for management of labor pain

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Created On: 23/12/2022

A randomized clinical trial was conducted to evaluate the effectiveness of programmed and epidural labor analgesia for labor pain management.

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Key take away

In women suffering from labor pain, epidural labor analgesia is superior to programmed labor analgesia in reducing pain.

Background

A randomized clinical trial was conducted to evaluate the effectiveness of programmed and epidural labor analgesia for labor pain management.

Method

Through the use of random allocation software, 72 parturients in active labor were divided into two equal groups. A 15 ml epidural injection of 0.2% Bupivacaine and 2 mcg/ml Fentanyl was administered to group 1. Top-up was administered in a graduated manner using the same dose schedule.

Pentazocine 6 mg intravenously + Injection Diazepam 2 mg intravenously + Injection Tramadol 1 mg/kg deep intramuscularly and thereafter Injection Drotaverine 40 mg intravenously half hourly (maximum of three doses) was administered to Group 2 as part of a programmed labor analgesia regimen. Use of Ketamine as rescue analgesia, 0.25–0.5 mg/kg intravenously was administered. A VAS score was used to evaluate the effectiveness of pain alleviation.

Result

The epidural group (Group 1) experienced improved labor analgesia, with VAS considerably decreasing at 5 minutes. Group 1 needed rescue analgesia with ketamine. Hemodynamics did not alter significantly. Mild side effects didn't require any treatment. The ambulation in Group 1 was unaffected. All group 2 cases requiring episiotomy required local anaesthetics. In neither group did the neonates experience any side effects.

Conclusion

For pain relief during labor, epidural labor analgesia is preferable to programmed labor analgesia. The duration of analgesia was shorter during programmed labor and inadequate pain alleviation was experienced. Neonatal outcome and delivery mode were unaffected. In programmed labor, pain treatment was inadequate, lasted for a shorter time, and necessitated rescue analgesia.