Aim of the study: To compare efficacy of tramadol injection as an opioid analgesia versus epidural analgesia on governing labor pain, progress and outcomes (maternal and fetal).
Duration and place of study: Department of Obstetrics and Gynecology Zagazig University from November 2011 to December 2013.
Methodology: One hundred fifty pregnant women primigravida had gestational age between 37 to 41 weeks (confirmed by early ultrasound) with vertex presentation without any risk factors, in established labor (cervical dilation >3cm with regular uterine contraction) were included in this study divided into two groups , tramadol group (A) and epidural group (B) . Subjects of group (A) received 1mg/kg tramadol intramuscular bolus and 100mg in 500 ml Ringer lactate at the rate of 8-24drops/min. and those of group (B) received 0.125% bupivacaine with fentanyl 5 mcg/ml 10- 15 mL to be repeated hourly throughout labor and continued until birth. Pain relief was assessed by visual analogue scale of 10 scores ranging from no pain to unbearable pain) before the administration of the drug at 0, 5min., 10min., 15min., 30min., 1 h then every 2 h until full dilatation. Maternal and neonatal out comes were determined.
Results: Total number of patients was one hundred fifty, all were primigravida.The mean age of group A was 22.81 ± 1.89 years and 23.23 ± 1.28 in group B; Mode ofdelivery was spontaneous vaginal in 64 patients (85.3%) in group A and 53 patients (70.6%) in group B Instrumental vaginal delivery in 6 patients (8%) of group A and 13 Patients (17.3%) of group B. Cesarean section in 5 patients (6.6%) of group A and 9 patients12% of group B. At one minute majority of the babies of group A had mean Apgar score 8.7 ± 0. 52 versus 8.65 ± 4.1 at group B. At 5 minute, 9.40 ± 0.33 versus 9.54 ± 0.23. There were no significant differences.In the tramadol group, pain relief was excellent in 13.3%, good in 30.6% and average in 54.6% versus 29.3%, 48% and 22.6% in epidural group. In both the groups there was no significant effect on duration of 1st and 3rd stage of labor but Second stage of labor was prolonged in the epidural group.
Conclusion: Epidural anesthesia and tramadol provided excellent pain relief in majority of the patients. Since, Tramadol administration is easy could be considered as a good alternative to epidural analgesia in lower source settings of the developing nations.