A prospective comparative study of effect of addition of dexmedetomidine 0.5 mcg/ml with 0.2% ropivacaine and 0.2% ropivacaine alone in epidural labour analgesia

Abstract

Introduction: The pain of childbirth is the most painful experience for many women and maternal request is a sufficient indication for providing her pain relief during labour. The McGill pain questionnaire ranks labour pain scale between cancer pain and amputation of a digit.1 Labour pain is associated with maternal physiological responses, which are not necessarily beneficial to the foetal well-being. Materials and Methods: This prospective, comparative study was going to be conducted at Department of anesthesia, Bidar Institute of Medical Sciences, Bidar during the period of November 2021 to April 2022. The sample size obtained was 38 for each group which was rounded up to 60 for each group. So final sample size estimated was 120. Reference article for sample size calculation is made based on the study conducted by Zhao Y et al. Total of 120 parturients of age group 20-35 yrs., Heights in cm: >150 cms, full term singleton vertex presentation, previous normal vaginal delivery, consented for the study, Primigravida and multigravida of physical status ASA grade I&II, foetus having normal heart rate pattern before induction of Epidural, Cervical dilatation of 3-5 cms were included in group and divided in 2 group using computer generated randomization technique. Results: The highest sensory level in both groups was observed at T6 (p=0.190). Total drug requirement in both groups was calculated. All the subjects 60 (100%) in both the groups required first and second dose of bolus. While third bolus was required only for 50 (83.3%) subjects of RD groups compared to 60 (100%) of RS group. Fourth bolus was required only for 34 (56.7%) subjects of RD groups compared to 50 (83.3%) of RS group. Fifth bolus was required only for 2 (3.3%) subjects of RD groups compared to 12 (20.0%) of RS group. There was statistically significant difference between the two groups for third (p=0.020), fourth (p=0.024) and fifth bolus (p=0.044). The total drug requirement for RS group (32.27+- 4.91) was significantly higher than the RD group (27.46 +or- 6.53), p value of 0.021. Conclusion: Epidural labour analgesia is considered to be a gold standard for pain management during labour, when ropivacaine along with dexmedetomidine is used. Many studies have been conducted to prove the use of dexmedetomidine in obstetric anesthesia in optimal doses. This wonder drug provides excellent maternal satisfaction and good progress of labour with minimal side effects to mother and foetus.