INTERMITTENT EPIDURAL BOLUSES OF ROPIVACAINE AND SUFENTANIL PROVIDE BETTER LABOR PAIN CONTROL AND IMPROVES LABOR OUTCOME: COMPARATIVE STUDY VERSUS CONTINUOUS EPIDURAL INFUSION
Mohamed A Khashaba, Islam A Shaboob
Department of Anesthesia, Pain & ICU, Faculty of Medicine, Benha University
Objectives: Evaluation of the analgesic efficacy and pregnancy outcome of parturient receiving intermittent epidural boluses (IEB) or continuous epidural infusion (CEI) of ropivacaine 0.15% and sufentanil 0.2 g/ml combination. Patients & Methods: 158 primipara were divided into two groups; CEI (Group I) received continuous infusion and IEB (Group II) received intermittent epidural boluses of ropivacaine 0.15% and sufentanil 0.2 g/ml combination. Efficacy of the procedure was evaluated using the Numeric rating scale (NRS) of pain and the Bromage score for motor block. The frequency of the need for labor augmentation, length of the 2nd stage of labor, mode of delivery and fetal outcome as judged by APGAR score, drug-related side effects and patients' satisfaction were recorded. Results Mean NRS pain scores showed non-significant difference between patients of both groups. Mean duration of the 2nd stage of labor was significantly (p=0.021) shorter in group II, the frequency of women required labor augmentation and cesarean section was significantly lower among those of group II. The frequency of neonates had APGAR score of 10 and excellent outcome was significantly in neonates of group II, but the frequency of parturient had nausea was significantly lower among parturient of group II. 83 parturient (52.5%) were most satisfied by the applied analgesic procedure, 51 parturient (32.3%) were satisfied and 18 parturient (11.4%) found the procedure is good modality of labor analgesia, while only 6 parturient (3.8%) found the procedure unsatisfactory. The frequency of women most satisfied and satisfied was significantly higher among those of group II in comparison to group I. Conclusion: Epidural labor analgesia is effective, safe and appropriate modality for women in active labor especially primipara. Both epidural pain control techniques provided analgesia of non-significant difference. However, IEP was superior to CEI for provision of less motor block, higher spontaneous and assisted VD, shorter 2nd stage and lower CS rate.
December 2018