Epidural Labor Analgesia during the First Stage of Labor: A Double-Blind Clinical Trial

Abstract

Background: although severe pain is not life-threatening in healthy parturient women, it can have neuropsychological consequences. Postnatal depression may be more common when analgesia is not used, and pain during labor has been correlated with the development of post-traumatic stress disorder. In addition, one study suggested that the impairment of cognitive function in the postpartum period can be mitigated by the use of any form of intrapartum analgesia.Aims: to compare a combination of epidural fentanyl and bupivacaine with bupivacaine alone for epidural analgesia in labor and to evaluate factors in addition to analgesia that may influence maternal satisfaction.Patients and methods: a double blind controlled clinical trial carried on 218 multiparous parturient. The patients were randomly allocated in 2 groups. Group 1 (n=109) had received bupivacaine 0.1% with fentanyl 50µg and group 2 (n=109) (control group) had received bupivacaine 0.1% only.Results: in the bupivacaine group, 40 cases (37.7%) had required 2 top-ups and 26 cases (23.9%) had asked for 3 top-ups. On the other hand 14 (12.8%) cases from bupivacaine fentanyl group had asked for 2 top-ups and no cases had recorded request for 3 doses, which was statistically significant (P<0.0001).Conclusions: maternal satisfactory rate is high in both groups; the bupivacaine fentanyl group had shown a good response to the effect of analgesia with the minimal medical intervention.