Combined Spinal Epidural Analgesia in Labour – Comparison between Levobupivacaine with Fentanyl and Fentanyl alone in Intrathecal Component

Abstract

Background: The combined-spinal epidural analgesia (CSEA) technique using intrathecal administration of low dose local anaesthetic drug with opioid to provide analgesia is a routinely practiced method of labour analgesia now-a-days. Levobupivacaine is a local anaesthetic which is very popular by virtue of the safety and fentanyl is an opioid which causes rapid onset and longer duration of profound analgesia. It can also be done with intrathecal fentanyl alone. This study compared the effect of intrathecal two drug regimen (Levobupivacaine with fentanyl and fentanyl alone) in combined spinal-epidural technique of labour analgesia. Objective: Evaluate the effect of Intrathecal Levobupivacaine with Fentanyl versus Fentanyl only for Combined Spinal - Epidural Analgesia in Labour. Method: This randomized controlled trial was conducted at labour suit of Department of Obstetrics and Gynaecology, Institute of Child and Mother Health (ICMH). A total of 50 primiparous parturients, 18-35 years old, ASA status I and II, full-term women admitted for labour analgesia were selected according to eligible criteria. Those who gave consent for the procedure were underwent a thorough pre-anaesthetic check up and were randomized into two groups, group A (LF group) and B (F group) according to the intrathecal drug delivery in combined-spinal epidural analgesia technique. Pain was measured using a 0 -100 mm visual analogue scale. Adverse effects such as hypotension, bradycardia, pruritus, urinary retention, nausea and vomiting were noted. All information was recorded in a preformed data sheet and statistical analysis was done by SPSS.22.0 Results: Onset of analgesia was significantly faster in group A (1.85 ± 0.49) than group B (5.57± 0.34) (p = 0.000) and pain intensity was less in group A than group B for first 30 mins. Parturients of group A developed some lower limb weakness but that was resolved later and there was no such weakness in group B. Maternal hypotension occurred significantly in group A with no such in group B. Seven out of 25 parturients in group A had instrumental delivery which was significantly higher than group B (no instrumental delivery) (p=0.001).More parturients in group A were satisfied of good quality of pain relief than group B (p =0.003). Conclusion: Intrathecal Levobupivacaine with Fentanyl produces adequate analgesia than Fentanyl only for Combined Spinal - Epidural Analgesia in Labour with more maternal satisfaction and with some non significant maternal side effects like lower limb motor block and hypotension.

JBSA 2023; 36 (1) : 9-15