title: I.V. paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour: a randomized controlled study.
abstract: BACKGROUND
  Use of i.v. paracetamol for postoperative pain is well documented, but it is unclear if it can reduce the consumption of opioids during patient-controlled epidural analgesia (PCEA) in labouring parturients.
  
  
  METHODS
  In this randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital,80parturients were randomly assigned to two groups of 40 each, to receive either 1000 mg (100 ml) i.v. paracetamol or 100 ml normal saline as placebo, 30 min before the procedure. After insertion of the epidural catheter, all patients received 10 ml of levobupivacaine 0.1% with 2 μg ml-1 fentanyl, followed by continuous background epidural infusion of 6 ml h-1 with a provision of patient-controlled bolus 5 ml of same drug with a lock-out interval of 12 min.The primary outcome was hourly mean consumption of levobupivacaine and fentanyl mixture (ml.h-1). Secondary outcomes included pain score ,: sensory and motor block, haemodynamic parameters of mother, duration of second stage of labour, mode of delivery, Apgar scores, foetal heart rate and adverse effects.
  
  
  RESULTS
  The hourly mean drug consumption in the Paracetamol group was significantly lower as compared with the Placebo group (7.03 ml.h-1, SD 0.83 vs. 8.12 ml.h-1, SD 1.34; p < 0.001). The mean number of boluses taken were also significantly less in the paracetamol group (1.00, SD 0.93 vs. 1.43, SD 0.90; p = 0.036). Pain scores decreased in both the groups without significant inter-group differences.
  
  
  CONCLUSIONS
  Use of 1000 mg i.v. paracetamol decreases the mean hourly drug consumption through epidural route. Thus i.v. paracetamol is a safe and effective adjunct to PCEA in labour analgesia.
  
  
  BACKGROUND
  Clinical Trials Registry-India (http://ctri.nic.in/Clinicaltrials/login.php), trial registration number 2013/09/003968.
authors: Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India.
authors: K
authors: K
authors: Gupta
authors: Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India drsmitra12@yahoo.com.
authors: S
authors: S
authors: Mitra
authors: Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India.
authors: S
authors: S
authors: Kazal
authors: Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India.
authors: R
authors: R
authors: Saroa
authors: Department of Anaesthesia & Intensive Care, Government Medical College & Hospital, Chandigarh, India.
authors: V
authors: V
authors: Ahuja
authors: Department of Obstetrics & Gynaecology, Government Medical College & Hospital, Chandigarh, India.
authors: P
authors: P
authors: Goel
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007743:Labor, Obstetric; D000077554:Levobupivacaine; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000082:Acetaminophen; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine
keywords: administration, intravenous; analgesia; analgesia, epidural; obstetric labour; paracetamol; patient-controlled