A Protocol on Comparative Evaluation of Epidural and Spinal Technique of Labour Analgesia in Rural Women of Central India and their Perceptions Regarding Pain Relief in Labour

Background: Labour pain while giving birth is one of the most excruciatingly painful and emotionally stressful experience for a woman that has piqued the interest of several academicians. Labour pain is induced due to the uterine ischemia, expansion of vagina and birth canal, muscle contractions, and pressure on the bladder. To relieve the severe pain during labour, analgesia is required, which offers pain relief without the loss of consciousness. Regional analgesia (Epidural and spinal) are most commonly used for offering pain relief to women. Aim: To evaluate whether low dose spinal analgesia is a better alternative to lumbar epidural analgesia for pain relief in labour. Objectives - Primary objective is to evaluate efficacy of lumbar epidural and spinal analgesia for pain relief in labour. Secondary objective is to evaluate the perceptions of women towards the use of labour analgesia, to evaluate the maternal and fetal outcome and to evaluate the barriers affecting the use of lumbar epidural and spinal analgesia for women during labour. Methods: In this randomized control trial study, where 60 patients are present in each group. Patients in GROUP E, epidural analgesia will be given using 18-gauge Touhy epidural needle by a loss of resistance to air technique, and after confirmation of space, an epidural catheter will be inserted cranially in L3 - L4 or L4-L5 interspace, and a dose of 15ml of 0.125% bupivacaine with 25µg of fentanyl would be given slowly. Group S patients will receive subarachnoid block using 25-gauge needle inserted and directed to reach the intrathecal space between L3 - L4 or L4 - L5 intervertebral space. After a successful Dural puncture with acceptable CSF flow, 0.1% bupivacaine 2ml with 25µg fentanyl will be given via spinal needle. Throughout the duration of delivery, hemodynamic monitoring including SPO2, ECG, heart rate and blood pressure of mother and fetal heart rate would be monitored under the guidance of obstetrician and anesthesiologists. Patient will be assessed every 5min for the first 15 min, and then every 15 minutes until additional analgesia was requested. The severity of labour pain would be assessed using visual analogue scale. (0 = no pain; 10 = severe pain). Within the first 24 - 48 hours postpartum patient will fill the self-administered questionnaires. Results: The groups are expected to be similar. However, Low dose spinal analgesia may be a better alternative to lumbar epidural analgesia in providing effective pain relief for women in labour in terms of cost effectiveness. There are no results found as it is just a protocol. Results are yet to come. Conclusions: The study would offer new insights and knowledge into the use of epidural and spinal analgesia in India, particularly Wardha. The perceptions of women, towards labour analgesia, its consequences or side effects, and the myths associated with its use will be comprehended.

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Awareness and perception of epidural labor analgesia among pregnant women visiting antenatal clinic in National Referral Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v16i1.37410 ◽

2021 ◽

Vol 16 (1) ◽

pp. 10-15

Author(s):

Tandin Tshomo ◽

Karma Tenzin ◽

Jamphel Tshering

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Pregnant Women ◽

Labour Pain ◽

Good Method ◽

Antenatal Clinic ◽

Cross Sectional Study ◽

Labour Analgesia ◽

Cross Sectional ◽

Labour Epidural Analgesia

Aims: To assess the awareness and perception of labour epidural analgesia among pregnant women visiting the antenatal clinic. Methods: This was an observational cross-sectional study. Study participants included pregnant women visiting the antenatal clinic during 2nd and 3 rd trimester conducted from 21 st September 2018 till 20 th September 2019. Data were collected by using an interviewer-administered questionnaire. Ethics approval was granted by the research Ethics Board of health, Bhutan. Results: Total 450 parturients participated in this study; 61.4% of the participants knew that labour epidural services were available and 37.5% got information through media. A total of 57.3% of respondents had severe fear about labour pain; 62.4% had severe fear about delivery complication; 85.2% thought that epidural labour analgesia was a good method of pain relief; and 67% were willing to accept it for their current pregnancy. However, 86.6% would recommend epidural labour analgesia as an option of pain relief to other pregnant women. Conclusion: Awareness about the availability of labour epidural analgesia services needs to be improved, as a majority of the parturient was keen to avail epidural analgesia after the information about its availability was provided.

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Patient-controlled epidural analgesia for labor – a step forward in Ukrainian obstetrics

Pain medicine ◽

10.31636/pmjua.v4i3.5 ◽

2019 ◽

Vol 4 (3) ◽

pp. 67-70

Author(s):

Yevhenii Grizhimalsky ◽

Andrii Harha

Keyword(s):

Patient Satisfaction ◽

Pain Relief ◽

Epidural Analgesia ◽

Local Anesthetics ◽

Gold Standard ◽

Severe Pain ◽

Labour Pain ◽

Randomized Controlled ◽

Randomized Controlled Studies

Labour pain is recognized by some women as the most severe pain that they have ever felt in their life. Epidural analgesia is an effective method of pain relief in labour and is considered as the gold standard of analgesia for delivery. Traditionally, epidural analgesia in Ukraine is performed without the ability for the patient to control the process of anesthesia. The authors became interested in the delivery of local anesthetics by patientcontrolled epidural analgesia instead of the traditional physician methods. In randomized controlled studies there is an evidence that the PCEA method tends to improve the quality of pain relief and increase the patient satisfaction.

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Pharmacological and Non-Pharmacological Methods of Labour Pain Relief—Establishment of Effectiveness and Comparison

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122792 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2792 ◽

Cited By ~ 5

Author(s):

Iwona Czech ◽

Piotr Fuchs ◽

Anna Fuchs ◽

Miłosz Lorek ◽

Dominika Tobolska-Lorek ◽

...

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Water Immersion ◽

Labour Pain ◽

Satisfaction Level ◽

Pain Level ◽

Mean Values ◽

Significant Difference ◽

Third Stage ◽

Water Birth

Background: To evaluate the effectiveness of pharmacological and non-pharmacological pain relief methods and to compare them. Materials and methods: 258 women were included in the study and interviewed using a questionnaire and the visual analogue scale for pain. They were divided into six groups depending on chosen method of labour pain relief: epidural anaesthesia (EA; n = 42), water immersion and water birth (WB; n = 40), nitrous oxide gas for pain control (G; n = 40), transcutaneous electrical nerve stimulation (TENS) (n = 50), multiple management (MM; n = 42), none (N; n = 44). Results: The average age of the women was 29.4 ± 3.74 years and 60.47% of them were nulliparous (n = 156). Mean values of labour pain intensity were 6.81 ± 2.26 during the first stage of labour; 7.86 ± 2.06 during the second stage, and 3.22 ± 2.46 during the third stage. There was no significant difference in pain level between epidural analgesia and gas groups in the first stage of labour (p = 0.74). Nevertheless, epidural analgesia reduced pain level during the second and third stage (both p < 0.01). The highest satisfaction level pertains to water immersion (n = 38; 95%). Conclusion: Epidural analgesia is the gold standard of labour pain relief, however water birth was found to be associated with the highest satisfaction level of the parturient women. The contentment of childbirth depends not only on the level of experienced pain, but also on the care provided to the parturient during pregnancy and labour.

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THE OCCURRENCE SEGMENTS DURING CONTINUOUS LUMBAR EPIDURAL ANALGESIA FOR PAIN RELIEF IN LABOUR

British Journal of Anaesthesia ◽

10.1093/bja/44.3.290-a ◽

1972 ◽

Vol 44 (3) ◽

pp. 290

Author(s):

ROGER FLETCHER ◽

J.C. RICHARDSON ◽

G.A. MEADOWS

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Lumbar Epidural Analgesia

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A Study of the Awareness and Acceptabilty of Labour Epidural Analgesia amongst Antenatal Clinic Attendees in One Tertiary Hospital

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1630619 ◽

2020 ◽

pp. 3-4

Author(s):

S. Eli ◽

D. G. B. Kalio ◽

N. A. E. Okeji ◽

B. O. A. Altraide ◽

P. Kua ◽

...

Keyword(s):

Pain Relief ◽

Epidural Analgesia ◽

Antenatal Clinic ◽

Tertiary Hospital ◽

Labour Analgesia ◽

University Teaching ◽

Middle Income ◽

Lack Of Information ◽

Low Middle Income Countries ◽

Labour Epidural Analgesia

Background: The benefits of Pain relief to parturients in labour cannot be over-emphasized. However, in low middle income countries accessibility, availability and affordability these services are not optimum. This has made it near impossible for women in labour to benefit from epidural analgesia. Aim: This study was aimed to assess the knowledge of availability and level of acceptance of labour analgesia amongst antenatal clinic attendees at the department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital (RSUTH). Methods: The present observational study was conducted after informed consent was given by antenatal clinic attendees. Data was collected using a pretested questionnaire and analyzed using SPSS Version 25. Results: Response from 200 women with mean ± SD age and gestational age of 31.49 ± 4.89 years and 34.25 ± 4.75 weeks respectively. The modal Parity was 1. 56; while 106/200 (53%) were aware of pain relief in labour, 94/200 (47%) had no knowledge of pain relief in labour. Twenty eight (28/106) constituting 26.42% had knowledge of the pharmacological methods while 78 (73.59%) had non-specific ideas about pain relief in labour. Twenty six (26/28) (92.86%) of the respondents will accept epidural analgesia in labour. Conclusion: Knowledge of availability and acceptance of labour analgesia was poor. Lack of information is a major contributor for non-acceptance of labour analgesia. The inclusion and dissemination of information about labour analgesia by anaesthetists and obstetricians during antenatal classes would increase the knowledge about its availability and wide acceptance to these parturients.

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