Role of the Single-shot Spinal Analgesia to Control Labour Pain
Status:
Unknown status
Trial end date:
2016-11-01
Target enrollment:
Participant gender:
Summary
Labor pain is the most severe pain most women will endure in their lifetimes. The most
complete and effective method of pain relief during childbirth is neuraxial labor analgesia
which provides adequate analgesia without maternal or fetal sedation. Epidural and combined
spinal-epidural (CSE) analgesia are the standard techniques performed in the developed
countries. Having an epidural catheter in place produces flexibility with labor management.
The catheter can be dosed intermittently for parturients in whom labor is prolonged, who
require surgical manipulation for vaginal delivery, or who require cesarean section for
delivery (1). However, unavailability of full-time epidural services in low-resource
countries results in minimal or no analgesia provided to laboring parturients. The
suitability of single-shot spinal analgesia has been previously studied in advanced, rapidly
progressing labor in primiparous and multiparous women and was found that it may be a useful
alternative for painless labor in the case of limited resources for epidural analgesia
(2,3,4). However, duration of action is a limiting factor of intrathecal analgesia,
particularly for primiparous women.
A 25 μg dose of fentanyl lasts 60-90 minutes. The study investigating the dose response
relation for intrathecal fentanyl showed that the maximal analgesic effect is achieved at
about 25 μg fentanyl. Above this dose, the duration of action increases but with increasing
the incidence of side effects (5). Synergy has been noted between 25 μg of fentanyl and 2.5
mg of bupivacaine with analgesia lasting about 3 hours (6). The investigators hypothesized
that increasing the bupivacaine dose to 5 mg with 25 μg fentanyl can prolong the duration of
analgesia. So, this dosage combination can be used at an early stage in
appropriately-selected primigravida parturients. The purpose of this study is to investigate
the safety and effectiveness of single-dose spinal analgesia to control labor pain in
properly-selected primiparous women in a tertiary referral maternity hospital