title: Butorphanol in labour analgesia: A prospective cohort study.
abstract: OBJECTIVE
  Parenteral opioids can be administered with ease at a very low cost with high efficacy as labour analgesia. However, there are insufficient data available to accept the benefits of parenteral opioids over other proven methods of labour analgesia. Butorphanol, a new synthetic opioid, has emerged as a promising agent in terms of efficacy and a better safety profile. This study investigates the effect of butorphanol as a labour analgesia to gather further evidence of its safety and efficacy to pave the way for its widespread use in low resource settings.
  
  
  METHODS
  One hundred low risk term consenting pregnant women were recruited to take part in a prospective cohort study. Intramuscular injections of butorphanol tartrate 1 mg (Butrum 1/2mg, Aristo, Mumbai, India) were given in the active phase of labour and repeated two hourly. Pain relief was noted on a 10-point visual pain analogue scale (VPAS). Obstetric and neonatal outcome measures were mode of delivery, duration of labour, Apgar scores at 1 and 5 minutes and Neonatal Intensive Care Unit admissions. Collected data were analysed for statistically significant pain relief between pre- and post-administration VPAS scores and also for the incidence of adverse outcomes.
  
  
  RESULTS
  Pain started to decrease significantly within 15 minutes of administration and reached the nadir (3.08 SD0.51) at the end of two hours. The pain remained below four on the VPAS until the end of six hours and was still significantly low after eight hours. The incidence of adverse outcomes was low in the present study.
  
  
  CONCLUSIONS
  Butorphanol is an effective parenteral opioid analgesic which can be administered with reasonable safety for the mother and the neonate. The study has the drawback of lack of control and small sample size.
authors.affiliation: Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Halder
authors.affiliation: Department of Obstetrics and Gynaecology, Sarojini Naidu Medical College, Agra, India.
authors.forename: Rachana
authors.initials: R
authors.lastname: Agarwal
keywords: Labour analgesia; butorphanol; visual pain analogue scale