Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 10 , ISSUE 3 ( July-September, 2018 ) > List of Articles


Quest for Labor Analgesia in Second Stage in Resource Poor Setup

Banashree Das, Ritu Khatuja, Shweta Mittal

Keywords : Analgesia, Case-control study, Pudendal nerve block (PNB), Randomized clinical trial, Second stage of labor

Citation Information : Das B, Khatuja R, Mittal S. Quest for Labor Analgesia in Second Stage in Resource Poor Setup. J South Asian Feder Obs Gynae 2018; 10 (3):194-198.

DOI: 10.5005/jp-journals-10006-1588

Published Online: 01-07-2015

Copyright Statement:  Copyright © 2018; The Author(s).


Aim: To assess the analgesic effect of pudendal nerve block (PNB) as labor analgesia in the second stage of labor, its effect on the duration of the second stage and to assess any adverse maternal and fetal outcome. Materials and methods: The prospective, randomized, casecontrol study (parallel group trial) was conducted with a total of 110 parturient women. They were randomly allocated to either study group (n = 55) or control group (n = 55). The study was performed after the approval of the institutional ethical committee. All the women recruited for the study were given first stage analgesia. The pain was assessed using the verbal rating scale. In the second stage of labor, the women in the study group were given transvaginal PNB (5 mL of 1% Lignocaine + 5 mL of 0.25% bupivacaine) bilaterally, whereas, in control group, no added analgesia was given. Statistical analysis: Quantitative data were compared using the unpaired t-test and qualitative data was compared using chi square test. p ≤ 0.05 has been taken as the level of statistical significance. The data were analyzed by Statistical Package for the Social Sciences (SPSS) statistical software version 17.0. Results: It was observed that in the second stage of labor, Pudendal Nerve Block produced pain relief in 98.2% women, out of which 14.6% had excellent pain relief and 52.7% had moderate pain relief. This was found to be statistically significant (p < 0.05). The mean duration of the second stage of labor was longer in the study group (29.02 minutes) than in the control group (16.86 minutes) (p < 0.05). There was no significant adverse maternal and fetal outcome. Conclusion: The PNB provides an effective analgesia in the second stage of labor without the major neonatal and maternal morbidity. Clinical significance: The PNB can be provided by obstetricians in any delivery setup, even in low resource settings, without the need for skilled anesthetists.

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  1. Simkin PP, O'hara M. Nonpharmacologic relief of pain during labor: Systemic reviews of five methods. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S131-159.
  2. Daftary SN, Desai SV, Thanawala U, et al. Programmed labor– indigenous protocol to optimize labor outcome. South Asian Feder Obstet Gynecol. 2009 Apr 25;1(1):61-64.
  3. Hawkins JL. Epidural analgesia for Labor and delivery. N Engl J Med. 2010 Apr 22;362(16):1503-1510.
  4. Caraceni A, Cherny N, Fainsinger R, et al. Pain measurement tools and methods in clinical research in palliative care: recommendations of an Expert Working Group of the European Association of Palliative Care. J Pain Symptom Manage. 2002 Mar;23(3): 239-255.
  5. Seymour RA. The use of pain scales in assessing the efficacy of analgesics in post operative dental pain. Eur J ClinPharmacol. 1982;23(5):441-444.
  6. King R. Perineal anesthesia in labor. SurgGynecol Obstet. 1916;23:615-618.
  7. Klink EW. Perineal nerve block; an anatomic and clinical study in the female. Obstet Gynecol. 1953 Feb;1(2):137-46.
  8. Kohl GC. New method of pudendal block. Northwest Med. 1954 Oct;53(10):1012-1013.
  9. Novikova N, Cluver C. Local anaesthetic nerve block for pain management in labor. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD009200.
  10. Mousa WF, Al-Metwalli RR, Mustafa M. Epidural analgesia during labor - 0.5% Lidocaine with fentanyl vs 0.08% ropivacaine with fentanyl. M.E.J. Anaesth. 2010 Feb;20(4):521-527.
  11. Fan Y, Ji M, Zang L, Wang W, Yin Q, Xu J et al. Comparison of epidural tramadol-ropivacaine and fentanyl-ropivacaine for labor analgesia: A prospective randomized study. Ups J Med Sci. 2011 Nov;116(4):252-257.
  12. Joel S, Joselyn A, Cherian VT, et al. Low-dose ketamine infusion for labor analgesia: A double-blind, randomized, placebo controlled clinical trial. Saudi J Anesth. 2014 Feb 1;8(1):6-10.
  13. Yuel V, Kaur V, Kaur D. Programmed Labor For Optimizing Labor And Delivery. JK Science. April-June2008;10(2):62-64.
  14. Kshirsagar NS, Patil SS, Karale AV. Comparative study of programmed labor and traditional management of labor. Int J Reprod Contracept Obstet Gynecol. 2013 Jun;2(2):209-212.
  15. Mousa WF, Al-Metwalli R, Mostafa M. Epidural analgesia during labor vs no analgesia: A Comparative Study. Saudi J Anaesth. 2012 Feb 21;6(1):36-40.
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