title: Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor.
abstract: BACKGROUND
  Neuraxial labor analgesia using new local anesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Combined spinal-epidural analgesia (CSEA) has become the preferred method for labor analgesia as it combines benefits of both spinal analgesia and flexibility of the epidural catheter. Adding opioids to local anesthetic drugs provide rapid onset and prolonged analgesia but may be associated with several maternal and fetal adverse effects. The purpose of this study is to compare fentanyl and tramadol used in CSEA in terms of duration of analgesia and frequency of the adverse fetomaternal outcome.
  
  
  METHODS
  A total of 60 primiparas with a singleton pregnancy in active labor were given CSEA after randomly allocating them in two groups of 30 each. Group I received intrathecal 2.5 mg levobupivacaine + 25 μg fentanyl followed by epidural top ups of 20 ml 0.125% solution of the same combination. Group II received 25 mg tramadol instead of fentanyl. Epidural top ups were given when parturient complained of two painful contractions (visual analogue scale ≥ 4). Data collected were demographic profile of the patients, analgesic qualities, side- effects and the fetomaternal outcome.
  
  
  RESULTS
  Patients in Group II had significantly prolonged analgesia (145 ± 9 minutes) than in Group I (95 ± 7 minutes). Patients receiving fentanyl showed rapid onset of analgesia, but there were more incidence of side-effects like shivering, pruritus, transient fetal bradycardia, hypotension, nausea and vomiting. Only side-effect in the tramadol group was nausea and vomiting. During labor, maternal satisfaction was excellent.
  
  
  CONCLUSIONS
  Adding tramadol to local anesthetic provides prolonged analgesia with minimal side effects. Fentanyl, when used as adjuvant to local anesthetic, has a rapid onset of analgesia but has certain fetomaternal side-effects.
authors.affiliation: Department of Medicine, Government Medical College, Amritsar, Punjab, India.
authors.forename: Veena
authors.initials: V
authors.lastname: Chatrath
authors.affiliation: Department of Medicine, Government Medical College, Amritsar, Punjab, India.
authors.forename: Ranjana
authors.initials: R
authors.lastname: Khetarpal
authors.affiliation: Department of Obstetrics and Gynaecology, Government Medical College, Amritsar, Punjab, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Government Medical College, Amritsar, Punjab, India.
authors.forename: Pratibha
authors.initials: P
authors.lastname: Kumari
authors.affiliation: Department of Medicine, Government Medical College, Amritsar, Punjab, India.
authors.lastname: Sudha
authors.affiliation: Department of Anesthesia, PIMS, Jalandhar, Punjab, India.
authors.forename: Kusum
authors.initials: K
authors.lastname: Bali
keywords: Combined spinal-epidural; fentanyl; labor analgesia; levobupivacaine; tramadol