COMPARISON BETWEEN FENTANYL 2 μG/mL VERSUS DEXMEDETOMIDINE 1.5 μG/mL AS ADJUVANTS WITH ISOBARIC BUPIVACAINE 0.0625% IN EPIDURAL LABOUR ANALGESIA

Abstract

BACKGROUND Low-dose bupivacaine with opioids like fentanyl have been used traditionally as an adjunct for epidural labour analgesia, but has side effects like pruritus, urinary retention, nausea, vomiting, etc. Dexmedetomidine, an α-2 adrenergic agonist with a high placental retention, decreased sympathetic outflow and norepinephrine release thereby causing sedation, anxiolysis, analgesia, sympatholysis and maternal haemodynamic stability. Hence, this study was carried out to compare dexmedetomidine and fentanyl as adjuvants in epidural labour analgesia. MATERIALS AND METHODS A prospective randomised, double-blind study was conducted in 60 term parturients in active labour of ASA I and II physical status. They were randomised into 2 groups with 30 parturients in each and received 15 mL of 0.0625% Inj. Bupivacaine plus either 1.5 μg/mL Inj. Dexmedetomidine (BD group) or 2 μg/mL Inj. Fentanyl (BF group). VAS, sedation scores, modified four grade Bromage scale, haemodynamics, peripheral oxygen saturation were recorded at baseline and regular intervals. When VAS was ≥4, subsequent doses of 5 mL of the respective group drug was administered. Parturients were ambulated when Bromage scale was 0 with no postural hypotension. Duration of analgesia, labour outcome, neonatal Apgar scores and side effects were noted. RESULTS Demography and haemodynamic stability were similar and comparable. Duration of analgesia was significantly longer in BD group (131.83±45.760) than BF group (85.33±22.512) (p<0.0001). More no. of top-ups was needed in BF group (1.80±1.518) than BD group (0.17±0.461) (p<0.0001). Significantly reduced VAS scores was observed in BD group than BF group. Mean sedation scores (p<0.05) and maximum Bromage scores (p=0.004) were significantly higher in BD group than BF group. Ambulation was less in BD group (3 parturients) than BF group (26 parturients). Side effects were significantly more in BF group than BD group (p=0.007). The labour outcomes were better in BD group than BF group and Apgar scores were comparable in both the groups. CONCLUSION Bupivacaine-dexmedetomidine provides longer duration and better quality of analgesia for labour pain control compared to bupivacaine-fentanyl without deleterious effects on newborns and labour outcomes.