The Role Of Epidural Fentanyl In Painless Labour

Abstract

Background: Epidural analgesia for providing Painless normal vaginal deliveries has been developed over the last 20 years,epidural local anaesthetics was the only available option. However, cetain drugs were added with the local anaesthetics to improves the quality of analgesia.
Aims : to ascertain the efficiency of fentanyl added to the epidural local anaesthetics in comparison with the use of an epidural local anaesthetics alone.
Patient and methods : This study was carried out on 30 parturients prepared for painless normal vaginal delivery under epidural analgesia in Al-khuder general hospital. Anaesthesiologist (ASA) classification were grade 1 between 20-40 of age with length taller than 160 cm.Subjects were allocated into two groups (15 patients in each group): Group A (n=15) received through an epidural catheter 8 ml lidocaine 0.75%+ 2ml normal saline for the first main dose and subsequent top up doses. Group B (n=15) received through an epidural catheter 8ml lidocaine o.75% + 20 microgram fentanyl diluted with normal saline to a total 2 ml volume for the first main dose and subsequent top up doses. Onset of action of local anaesthetic , the interval from initial bolus dose to the maternal request for additional analgesia , the number of top up doses and the neonatal condition in both groups were recorded.
Results : the group B is associated with shorter onset of action , longer interval from initial bolus dose to the maternal request for additional dose and a lesser number of top up doses than group A. The effect on neonatal condition manifested by APGAR score at 5 minute after delivery is similar in both groups.
conclusions : 20 microgram of fentanyl added to the usual dose of local anaesthetic epidurally is safe , effective and much better than the use of epidural local anaesthetic alone.