الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Labor pain is one of the major issues obstetricians face all over the globe requiring proper management protocols to improve and enhance level of medical care offered for women particularly in active phase of labor. Pain during labor originates from various sources such as uterine contractions and cervical dilatation proper control of pain is beneficial for proper normal progress of labor without jeopardizing maternal or fetal clinical status. Various agents have been extensively tested and investigated with different response levels (Bataille et al., 2014; ACOG, 2016).
Opioids are considered one of the cornerstone agents implemented in management of pain during labor having the feasibility to be administered intravenously or intramuscularly. Nalbuphine Hydrochloride injection is one of the opioid family commonly used in laboring cases that controls severe levels of pain however some case scenarios face undesirable side effects such as vomiting and fetal distress that is considered a critical issue in obstetric practice; however, proper protocol implementation in administration of the agent minimizes the harmful possible side effects and reduces the draw backs (Aweda et al., 2016).
On the other hand Paracetamol an effective and safe analgesic that is administered in intravenous form besides its famous oral form have a growing interest to be investigated in obstetric pain management protocols due to higher safe profile in practice the mechanism of action. Paracetamol / acetaminophen is one of the most commonly administered analgesic and antipyretic agents all over the globe; furthermore, it is the agent of choice in cases that cannot be managed with non-steroidal anti-inflammatory drugs (NSAID), e,g bronchial asthma, peptic ulcer disease, hemophilia, salicylate-sensitized people, , pregnant with growing research interest to be used in labor pain control and management (Azam Foroughipour et al., 2011).
Intravenous paracetamol is approved for the treatment of pain and fever in several countries worldwide. Intravenous paracetamol is administered as a 15-minute infusion. The recommended dosage in adults and adolescents weighing >50 kg is 1 g up to four times per day, with a minimum interval of 4 hours between doses and a maximum daily dose of 4 g (Shahid et al., 2015).
The current research study mainly aimed to compare efficacy and safety between intravenous nalbuphine and intravenous paracetamol as regards pain relief efficiency within the first stage of labor. This study was performed on 120 women primigravida with term and viable pregnancy, presenting with the vertex attending the labor ward for delivery in Ain Shams Maternity Hospital. The patients after fulfilling the inclusion criteria were divided into two groups P (giving paracetamol) and group N (giving nalbuphine). Pain assessment was performed by VAS and verbal rating scale of pain.
The data was obtained tabulated and analysed by SPSS computer software. There was no statistically significant difference between research groups was observed as regards verbal rating scale, however there was highly significant difference over the periods as labour progress this is markedly decrease in the effect of paracetamol and nalbuphine in decrease the pain through verbal rating scale in each research group (p values <0.001). Interestingly in addition no statistically significant difference between research groups according to visual analogue scale, on the other hand highly significant difference over the periods through visual analogue scale rating scale in each research group (p values <0.001). The variation between VAS and VRS due to as it depend on patient understanding of the pain and pain scales. The nalbuphine research group had statistically significant lower Apgar scoring levels that issue is justified by the resperitaroy depressive impact of opioid analgesic agents in comparison to paracetamol with no known impact on respiratory systems in therapeutic doses raising the safety profile level of paracetamol as regards neonatal respiratory wellbeing.
As regards the paracetamol research group statistically significant difference between PV<7cm and PV≥7cm according to VRS from 30min to 4 hrs and statistically significant difference between PV<7cm and PV≥7cm according to VAS from 1hrs to 4 hrs. As regards nalbuphine research group statistically significant difference between PV<7cm and PV≥7cm according to VRS from 1sthr to 4 hrs and statistically significant difference between PV<7cm and PV≥7cm according to VRS from 1sthr to 4 hrs. That mean cervical dilatation markedly effect in increasing pain.
Furthermore, no statistical significant difference as regards demographic features between both research groups, both agents had no impact on uterine contractions and no hypersensitivity issues were observed.
Conclusions
Both agents paracetamol and nalbuphine are effective as regards pain management during first stage of labor. However the safety profile of paracetamol on neonatal APGAR scoring is much higher than nalbuphine.
Recommendations
Paracetamol is highly recommended to be used for the pain relief as it is effective, cheap, highly available and safe medication during the first stage of labour. So, we recommended the use of paracetamol.