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Labor is considered one of the most intense and stressful experiences. Labor pain often causes a strong stress response in women. Labor analgesia refers to the use of various methods to reduce labor pain. Epidural block anesthesia has been one of the most common used analgesic methods for labor pain.
Several adjuvant drugs have been used in combination with the epidural local anesthetic to minimize the side effects of local anesthetics and prolong the duration of analgesia. These adjuvants include opioids such as morphine, fentanyl, and nalbuphine, α-2 agonists such as clonidine and dexmedetomidine, magnesium sulfate and neostigmine.
In this study, the analgesic effects of bupivacaine 0.25 % in combination with dexmedetomidine (group A) in comparison to nalbuphine (group B) in women in labor were observed. VAS score for pain was recorded along with the duration of stages of labor and the hemodynamics parameters in the participants. Also the APGAR score of the neonates was studied. Moreover, undesirable side effects were observed.
64 patients were randomly allocated into two equal groups (32 parturients): group (A) and group (B).
● group A (Dexmedetomidine group) received a bolus of 12ml volume consisting of 11ml of 0.25% bupivacaine and 0.5μg/ml dexmedetomidine (1ml volume) through the
epidural catheter and then a top up dose of 6ml volume consisting of 5ml of 0.25% bupivacaine and 0.5μg/ml dexmedetomidine (1ml volume) were given when VAS score becomes 4 or more.
● group B (Nalbuphine group) received a bolus of 12 ml volume consisting of 11ml of 0.25% bupivacaine and 10mg nalbuphine (1ml volume) through the epidural catheter and then a top up dose of 5ml of 0.25% bupivacaine and 2mg nalbuphine (1ml volume).
All participants were clinically assessed and routine preoperative investigations were done: CBC, Coagulation profile, liver function tests, kidney function tests and ECG.
The initial vital data were measured after applying the standard monitoring including pulse oximetry, non-invasive blood pressure and ECG. All patients received a preload of 10 ml/kg of plain Ringer‘s solution before the blockade.
This study showed that the addition of dexmedetomidine or nalbuphine to bupivacaine in epidural analgesia achieved satisfactory labor analgesia. There was no significant difference between the 2 groups in demographic data, duration of 1st stage and 3rd stage of labor nor neonatal APGAR score. Adding to this, there was no significant difference between the 2 groups in SO2. On the other hand, there was a significant prolongation in the duration of 2nd stage of labor in the dexmedetomidine group
more than in the nalbuphine group. As regard the VAS score and the hemodynamic parameters, there was a significant decrease in both of them only at 30 and 60 mins in the dexmedetomidine group more than in the nalbuphine group. It was also noticed that parturients in dexmedetomidine group developed bradycardia more than those in the nalbuphine group. On the contrary, parturients in the nalbuphine group recorded developing itching more than those in the dexmedetomidine group.