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Epidural analgesia, Nulliparous, Duration of labour
Background: For women in labour, pain alleviation is crucial. There are several pharmacological approaches to treat the pain including opioid injections, local analgesia, and Nitrous Oxide inhalation. The technique of epidural analgesia, which is frequently used as a kind of pain treatment during childbirth, involves injecting a local anaesthetic in lower region of spine to relieve pain. Unintended negative effects on the mother and child remain a concern, though.
Objective: This research was carried out to compare the mean duration of labour in nulliparous females with and without epidural analgesia.
Study Design: A randomized Control Trial
Place And Duration: This study was conducted in Jinnah Hospital, Lahore from March 2019 to March 2020
Methodology: A total of 400 patients were enrolled in the study, 200 were placed in Group I and 200 in Group II. In Group I a bolus injection of 10 ml of ropivacaine 0.2% and 50µg fentanyl was given and after 5 minutes a test dose of 3 ml lidocaine (2%) was given. In Group II, patients were not given epidural anesthesia. Data was entered and analyzed using SPSS version 23.
Results: According to the findings of the study, the patients ranged between 18-45 years of age, the mean age of patients in Group-I and Group-II was 30.5±7.43 and 30.3±7.91 years respectively. The mean gestational age in Group-I & II was 38.7±1.21 and 39.0±1.4 weeks respectively. We observed that the mean duration of 1st stage of labour in Group-I and II was 3.92±0.65 hours and 4.87±0.82 hours (p<0.001) while the mean duration of 2nd stage of labour in Group-I and II was 30.12±3.49 minutes and 26.37±2.15 minutes (p<0.001).
Conclusion: In conclusion, epidural analgesia in nulliparous women caused the first stage of labour to last less time and the second stage to last longer than it would have otherwise.
2. Bilic N, DjakoviE I, Klidan-Jai6 K, Rudman SS, Ivanec L. Epidural Analgesia in Labour- Controversies. Acta Clinic Croatica 2015;54:330-6.
3. Grisaru-Granovsky S, Bas-Lando M, Drukker L, Haouzi F, Farkash R, Samueloff A, et W. Epidural analgesia at trial of labour after cesarean (TOLAC): a significant adjunct to successful vaginal birth after cesarean (VBAC). J Perinat Med 2018;46: 261-9.
4. Agrawal D, Makhija B, Arora M, Haritwal A, Gurha P. The effect of epidural analgesia on labour, mode of delivery and neonatal outcome in nullipara of India, 2011-2014. J Clin Diagn Res 2014;8:0003-6.
5. Jones L. Pain management for women in labour: an overview of systematic reviews. J Evidence Based Med 2012;5:101-2.
6. Antonakou A, Papoutsis D. The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series. Obstet Gynecol Int 2016;2016:5740534.
7. Silva M, Halpern SH. Epidural analgesia for labour: Current techniques. Local and Regional Anesthesia 2010;3:143–53.
8. Leighton BL, Halpern SH. The effects of epidural analgesia on labour, maternal, and neonatal outcomes: a systemic review. Am J Obstet Gynecol 2002;186:S69–77.
9. Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology 1997;86:277-84.
10. Chestnut DH. Anesthesia and maternal mortality. Anesthesiology 997;86:273-6.
11. Roberts CL, Algert CS, Douglas I, Tracy SK, Peat B. Trends in labour and birth interventions among low-risk women in New South Wales. Aust N Z J Obstet Gynaecol 2002;42:176-81.
12. Thorp JA, Hu DH, Albin RM, McNitt J, Meyer BA, Cohen GR, et al. The effect of intrapartum epiduralanalgesia on nulliparous labour: a randomized, controlled, prospective trial. Am J Obstet Gynecol 1993;169:851-8.
13. Shahani Z, Shaikh AR, Gemnani VK, Abro K, Aizuddin AN, Manaf MR, Shahani MP. Neonatal Morbidity Patterns and Admission Outcomes: A Cross Sectional Study at a Tertiary Care Hospital in Pakistan. Journal of Pharmaceutical Research International. 2022 Jan 10:72-6.
14. Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labour: a meta- analysis. JAMA 1998;280:2105-10.
15. Bhutto AA, Rehman SU, Abro HA, Shahani MP, Ali F, Qazi A. FREQUENCY OF CARDIAC ABNORMALITIES IN PATIENTS PRESENTING WITH SYSTEMIC LUPUS ERYTHEMATOSUS AT TERTIARY CARE HOSPITAL, KARACHI.
16. Wong CA, Scavone BM, Peaceman AM. The risk of cesarean delivery with neuraxial analgesia given early versus late in labour. N Engl J Med 2005;352: 655-65.
17. Fyneface-Ogan S, Mato CN, Anya SE. Epidural anesthesia: views and outcomes of women in labour in a Nigerian hospital. Ann Afr Med 2009;8:250-6.
18. Tsen LC, Thue B, Datta S, Segal S. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia?. Anesthesiology 1999;91:920-5.
19. Sharma SK, McIntire DD, Wiley J, Leveno KJ. Labour analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology 2004;100:142-6A.
20. Sieńko J, Czajkowski K, Swiatek-Zdzienicka M, Krawczyńska-Wichrzycka R. Znieczulenie zewnatrzoponowe porodu u pierwiastek z ciaza donoszona [Epidural analgesia and the course of delivery in term primiparas]. Ginekol Pol 2005;76: 806-11.
21. Liang CC, Wong SY, Chang YL, Tsay PK, Chang SD, Lo LM. Does intrapartum epidural analgesia affect nulliparous labour and postpartum urinary incontinence? Chang Gung Med J 2007;30:161-7.
22. Raja KS, Tasleem H. Influence of epidural analgesia on frequency of instrumental delivery and duration of labour. Rewal Medical J 2009;34: 86–8.
23. Bofill JA, Vincent RD, Ross EL. Nulliparous activelabour, epidural analgesia, and cesarean delivery for dystocia. Am J Obstet Gynecol 1997;177:1465-70.
24. Muzaffar M, Wadho S, Zahid S, Sarki S, Akbar A, Rahim A, Balouch MP. THE EMERGENCE OF PRE-EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS AMONG NEWLY DIAGNOSED MDR-TB PATIENTS IN THE LARKANO REGION, SINDH.
25. Shahani MP, Humayun A, Shaikh Z, Siddiqui I, Khoso MH, Naz S, Siyal FJ, Unar K, Unar AA, Saleem R, Advani RS. Obesity associated hypertension in university staff at SMBBMU Larkana, Pakistan. Journal of Pharmaceutical Research International. 2021 Apr 3;33(20A):39-43.
26. Nafisi S. Effects of epidural lidocaine analgesia on labour and delivery: a randomized, prospective, controlled trial. BMC Anesthesiol 2006;6:15.