Abstract

Background and Aim: Central Neuraxial analgesia is the most versatile method of labour analgesia and the gold standard technique for pain control in obstetrics that is currently available.  The satisfaction of birth experience is greater with neuraxial techniques. Neuraxial analgesia is the mainstay analgesic, frequently administered to women in labor.we aimed at comparing efficacy of two regional techniques for labour analgesia by combined spinal epidural analgesia versus epidural analgesia evaluating by onset of analgesia, duration of analgesia, maternal satisfication, mode of delivery, neonatal outcome, complications(maternal and fetal).

Materials and Methods: 40 parturient of ASA physical status I or II in active labor with a cervical dilatation of 3-6cm requesting labour analgesia were motivated and enrolled were divided into two groups.

Group A:Received combined spinal Epidural technique using Intrathecal dose 1ml of solution containing 1 mg of 0.5% Hyperbaric Bupivacaine + 25mcg Fentanyl .Followed by subsequent top ups on patient demand using  10ml of solution containing 0.1% Bupivacaine + 2 ug/ml of Fentanyl. Group B: Received Epidural analgesia bolus dose of 10ml solution 0.1% Bupivacaine+2mcg/ml of Fentanyl.  Intermittent top ups on patient demand using 10ml solution containing 0.1% Bupivacaine + 2 mcg/ml of Fentanyl .Onset of analgesia, Mode of delivery, Neonatal outcome, Maternal satisfaction, Complications (maternal and fetal) were assessed. pain intensity by using a numerical rating scale and motor block by using bromage scale.

Results: Eighteen parturients from CSEA had onset of analgesia in less than 5 min, twelve parturient from LEA group had Onset of analgesia between 11 to 15 min and seven parturients had onset of analgesia between 16-20min. The mean time of onset of analgesia in Group A was 5.05 ±2.25 Min. The mean time of onset of analgesia in Group B was 15.2 ± 1.93 Min. Eighteen parturients from Group had undergone normal vaginal delivery. One parturient from Group B had underwent caesarian section for different indication. One parturient from Group B had undergone delivery in instrumental mode. All the Neonates from Group A and Group B had Apgar score of at 5th min of delivery. There was no difference in neonatal outcome between two groups. Five parturients in Group A complained of Pruritis and none of the parturients in group B complained of pruritis. Two parturients from each group had Hypotension. None of the parturients in neither group had other Complications like nausea and vomiting, non progressive labor or fetal distress.

Conclusion: From the present study we conclude that both the techniques Combined spinal Epidural and Epidural for labor analgesia produce excellent analgesia. However the CSE technique had faster onset of analgesia when compared to Epidural technique. Both the technique were similar in terms of safety and efficacy.

Keywords: Labour analgesia, Combined spinal epidural analgesia, epidural analgesia.