Citation Information :
Rathod S, Syal GG, Sood R, Syal K. Intrathecal Labor Analgesia Using Dexmedetomidine: A Viable Alternative to Epidural Analgesia. J South Asian Feder Obs Gynae 2021; 13 (5):279-282.
Aims and objectives: The aims and objectives of the study were to compare the safety and efficacy of single dose intrathecal analgesia using bupivacaine and fentanyl with either dexmedetomidine or morphine on maternal and fetal outcome.
Materials and methods: One-hundred and twenty parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4–6 cm were enrolled for the study. They were randomized into two groups of 60 each. Group I received dexmedetomidine 5 µg (1 mL) and group II received morphine 250 µg (1 mL) along with 0.5% bupivacaine heavy 2.5 mg (0.5 mL) + Fentanyl 25 µg (0.5 mL). Progress of labor, duration of analgesia, and neonatal APGAR score was recorded and compared between the two groups.
Result: The mean rate of cervical dilatation in group I was 1.63 ± 0.135 cm/hour whereas it was 1.54 ± 0.156 cm/hour in group II (p = 0.001). The mean total duration of labor in group I was 682.35 ± 60.920 minutes whereas it was 771.63 ± 52.016 minutes (p = 0.005). In the group I, 98.3% (59/60) had NVD, 1.7% (1/60) had IVD, and none had cesarean delivery. Similarly 75% (45/60) had NVD, 15% (9/60) had IVD, and 10% (6/60) had cesarean delivery in the group II. This difference was statistically significant (p = 0.001). However, duration of the second stage of labor, duration of labor analgesia, maternal satisfaction, and APGAR score did not differ in the two groups.
Conclusion: Single-shot intrathecal labor analgesia using combination of bupivacaine (2.5 mg), fentanyl (25 µg), and dexmedetomidine (5 µg) is a safe, effective, reliable, cheap, and satisfactory method of pain relief for labor and delivery.
Choudhary J, Sharma H, Acharya V. Maternal and fetal outcome in epidural analgesia study. Int J Reprod Contracept Obstet Gynecol 2016;5(10):3547–3551. DOI: 10.18203/2320-1770.ijrcog20163441.
Mathur P, Jain N, Prajapat L, et al. Effect of intrathecal analgesia using fentanyl and bupivacaine on progress of labor. J Obstet Anaesth Crit Care 2018;7(1):47–51. DOI: 10.4103/2249-4472.194297.
Westgren M, Lindahl SGE, Norden NE. Maternal and fetal endocrine stress response at vaginal delivery with and without an epidural block. J Perinatal Med 1986;14(4):235–241. DOI: 10.1515/jpme.1918.104.22.168.
Fyneface-Ogan S, Gogo Job O, Enyindah CE. Comparative effects of single shot intrathecal bupivacaine with dexmedetomidine and bupivacaine with fentanyl on labor outcome. ISRN Anesthesiol 2012; 2012:1–6. DOI: 10.5402/2012/816984.
Grewal A. Dexmedetomidine: new avenues. J Anaesthesiol Clin Pharmacol 2001;27(3):297–302. DOI: 10.4103/0970-9185.83670.
Gehan FE, Heba MF, Hussein M, et al. Effect of intrathecal dexmedetomidine on the quality of combined spinal epidural analgesia and obstetric outcome during vaginal delivery. Res Opin Anaesth Intensive Care 2017;4(1):23–28. DOI: 10.4103/2356-9115.202696.
Hess PE, Vasudevan A, Snowman C, et al. Small dose bupviacaine-fentanyl spinal analgesia combined with morphine for labor. Anaesth Analg 2003;97(1):247–252. DOI: 10.1213/01.ane.0000066520.30763.b8.
Viitanen H, Viitanen M, Heikkila M. Single-shot spinal block for labour analgesia in multiparous parturients. Acta Anaesthesiol Scand 2005;49(7):1023–1029. DOI: 10.1111/j.1399-6576.2005.00803.x.
Dostbil A, Celik M, Alici HA, et al. Maternal and neonatal effects of adding morphine to low-dose bupivacaine for epidural labor analgesia. Niger J Clin Pract 2014;17(2):205–210. DOI: 10.4103/1119-3077.127559.
Yeh HM, Chen LK, Shyu MK, et al. The addition of morphine prolongs fentanyl-bupivacaine spinal analgesia for the relief of labor pain. Anaesth Analg 2001;92(3):665–668. DOI: 10.1097/00000539-200103000-00022.
Owen MD, Ozsarac O, Sahin S, et al. Low-dose clonidine and neostigmine prolong the duration of intrathecal bupivacaine – fentanyl for labor analgesia. Am Soc Anaesthesiol 2000;92(2):361–366. DOI: 10.1097/00000542-200002000-00016.
Nelson KE, Rauch T, Terebuh V, et al. A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Am Soc Anesthesiol 2002;96(5):1070–1073. DOI: 10.1097/00000542-200205000-00007.
Minty RG, Kelly L, Minty A, et al. Single-dose intrathecal analgesia to control labour pain. Is it a useful alternative to epidural analgesia? Can Fam Physician 2007;53(3):437–442. PMID: 17872679.
Madishetti ER, Aasim SA. A comparative prospective study of intrathecal dexmedetomidine-fentanyl for labor analgesia. J Adv Med Dent Sci Res 2018;6(1):93–97. DOI: 10.21276/jamdsr.
Shah V, Bajaj M, Verma J. Randomized comparative study of intrathecal administration of dexmedetomidine-fentanyl for labour pain. Natl J Integr Res Med 2018; 9(1):88–91. Retrieved from: http://nicpd.ac.in/ojs-/index.php/njirm/article/view/1859.
Dilesh PK, Eapen S, Kiran S, et al. A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia. J Obstet Anaesth Crit Care 2014;4(2):69–74. DOI: 10.4103/2249-4472.14 3875.
Samal S, Pattnaik SK, Mohta A, et al. Intrathecal dexmedetomidine versus morphine as adjuvant to bupivacaine in LSCS. Indian J Clin Anaesth 2016;3(4):607–610. DOI: 10.18231/2394-4994.2016.0023.
Gupta R, Verma R, Bogra J, et al. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol 2011;27(3):339–343. DOI: 10.4103/0970-9185.83678.
Tshibuyi PN, Olang POR, Ogutu O, et al. A comparative study on the efficacy of two regimens of single-shot spinal block for pain relief in women presenting in established labour. East Afr Med J 2013;90(1):12–18. PMID: 26862625.
Anabah T, Olufolabi A, Boyd J, et al. Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation. South Afr J Anaesth Analg 2015;21(1):19–22. DOI: 10.1080/22201181.2015.1013322.
Girgin NK, Gurbet A, Turker G, et al. Intrathecal morphine in anaesthesia for cesarean delivery: dose-response relationship for combinations of low dose intrathecal morphine spinal bupivacaine. J Cin Anesth 2008;20(3):180–185. DOI: 10.1016/j.jclinane.2007.07.010.
Singh SN, Subedi A, Prasad JN, et al. Effect of intrathecal bupivacaine with morphine or butorphanol. Health Renaissance 2013;11(3): 246–249. Available from: https://doi.org/10.3126/hren.v11i3.9640.
Dani C, Perugi S, Fontanelli G, et al. Effects of epidural and systemic maternal analgesia in term infants: the NoPiL study. Front Biosci (Elite Ed) 2010;2:1514–1519. DOI: 10.2741/e210.
Eid HE, Shafie MA, Youssef H. Dose related effect of intrathecal dexmedetomidine with hyperbaric bupivacaine – a prospective randomized double blind study. Ain Shams J Anesthesiol 2011; 4:83–95.
Nair AS, Sriprakash K. Dexmedetomidine in pregnancy: review of literature and possible use. J Obstet Anaesth Crit Care 2013;3(1):3–6. DOI: 10.4103/2249-4472.114253.
Palanisamy A, Klickovich RJ, Ramsay M, et al. Intravenous dexmedetomidine as an adjunct for labor analgesia and cesarean delivery anesthesia in a parturient with a tethered spinal cord. Int J Obstet Anesth 2009;18(3):258–261. DOI: 10.1016/j.ijoa.2008.10.002.