Walking epidural with low dose bupivacaine plus tramadol on normal labour in primipara

To determine the obstetric outcome in terms of duration of labour and mode of delivery between the walking epidural analgesia with 0.1% Bupivacaine + 0.5% tramadol and routine labour practice.

Non-randomized controlled trial.

Department of Anaesthesia, Military Hospital, Rawalpindi, from August 2004 to July 2007.

Consecutive 50 primiparous patients, ASA-I, coming to antenatal clinic for routine delivery were included in control group-A, and consecutive 50 primiparous ASA-I, coming to antenatal clinic and requesting for painless delivery were included in group-B. In group-A, only injection Nalbuphine 10 mg intramuscular was given when pain was unbearable, on patient's request as a routine practice. In group-B epidural analgesia was given with 15 ml of 0.1% Bupivacaine + 0.5 mg/ml Tramadol. First stage, second stage and total duration of labour were noted. Mode of delivery was also recorded in both groups. Patient satisfaction was assessed by interviewing the parturient at evening round after delivery.

In group-A, first stage duration of labour was 6.72 + or - 1.16 hours and in group-B, it was 4.03 + or - 1.00 hours, (p < 0.001). Second stage of labour in group-A was 0.55 + or - 0.35 hours and in group-B it was 0.67 + or - 0.33 hours; (p=0.072). Total duration of labour, in group-A was 7.57 + or - 1.13 hours and in group-B it was 4.77 + or - 1.21 hours, (p < 0.001). In group-A 46/50 (92%) patients were delivered spontaneously, while 4/50 (8%) required instrumental assistance. In group-B 36/50 (72%) patients were delivered spontaneously and instrumental deliveries were 13/50 (26%) (p=0.015). One patient developed fetal distress and went through cesarean section in group B. Patient satisfaction was excellent in 88% of group-B parturients.

Epidural analgesia with combination of low concentration of Bupivacaine, injection Tramadol and ambulation markedly reduce the duration of labour.