A Comparative study of Entonox Versus Epidural (0.125 % Bupivacaine with 2 µgm/ml fentanyl) for Labour Analgesia

Mohamed Ali Khan, F (2006) A Comparative study of Entonox Versus Epidural (0.125 % Bupivacaine with 2 µgm/ml fentanyl) for Labour Analgesia. Masters thesis, Stanley Medical College, Chennai.


Download (9MB) | Preview


INTRODUCTION: “May no living being suffer from pain” -Lord Buddha. I start my study with homage to this noble sentiment. The severity of labor pain was recognized by the Romans, who termed delivery the poena Magna -the “great pain” or “great punishment.” Pregnancy, though is one of the most pleasant part of a woman’s life is marred by the anxious awaiting of a painful labour. Although labor is painless in a few women, the vast majority considers it painful, and a clear majority rates it as severe pain. Melzack, one of the authors of the gate control theory of pain, developed a questionnaire to assess the intensity and emotional impact of pain. Using this tool, he observed that labor pain was rated as more painful than cancer pain and that, among nulliparous women with no prepared childbirth training, it was nearly as painful as amputation of a digit without anesthesia. IASP defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of the actual damage.” This definition embraces various concepts especially the subjectivity of the symptoms which is the basis of the non-pharmacological options in the treatment of labor pain. AIM: 1. To compare Entonox with Epidural Technique ( 0.125 % Bupivacaine with 2 μgm/ml Fentanyl) for labour analgesia in, Effectiveness of pain relief, Duration of Labour, Foetal outcome. 2. To study the influence on maternal and foetal parameters. MATERIALS AND METHODS: The Current study was conducted in the Govt. RSRM lying in hospital. Chennai. Forty healthy primi parturients aged between 19-25 years were selected for study. The selection was purposive and patients with ASA class 1 physical status were taken up. Institutional approval was obtained. A prospective randomized trial was conducted. Randomization was done by Third party selection marked slips for each patient. Inclusion criterion: Primipara, Age 18 to 28 years, Weight 45 to 60 kgs, Height 145 to 165 cms, ASA class I, Cervical dilation 3 - 5 cms, Effacement > 50 percent, Willingness for Epidural, Willingness for Entonox, Able to understand usage of Entonox. Exclusion Criterion: Patient refusal, Multipara, Age, Weight, height parameters outside the range in the inclusion criterion. Any co- morbid condition (Diabetes, PIH, Cardiac disease, etc.). Any obstetric complications. Any of the exclusion criterion for Entonox. METHODOLOGY: The patients were counseled at the beginning of the procedure about the Technique for which they were randomized. This was to gain the trust of the patients and as for Entonox the correct technique for using it was taught to the patient. Here some patients who could not understand the correct usage either due to language problem were excluded from the study. Consent was obtained, complications explained and a brief physical status examination was done. All baseline parameters like Heart rate, respiratory rate, Systolic and Diastolic Blood Pressure, FHR, SPO2, Baseline VAS, were evaluated and recorded. The patients were explained in detail about the visual analogue score and its usage. All doubts were cleared and a baseline VAS was recorded. SUMMARY: In this study the Epidural group offered better pain relief than the Entonox group. The Entonox group offered reasonable relief of pain in the first stage though its effectiveness was not good in the second stage. Duration of labour, both the First stage and the Second stage were prolonged in the Epidural group than in the Entonox group. The total duration of labour was hence prolonged in the Epidural group. Fetal outcome as assessed by the Apgar score at 1 minute and 5 minutes were comparable and all the babies were healthy in this study. There was no appreciable fall in oxygen saturation in both groups, The incidence of side effects like urinary retention was more in the Epidural group and there were more incidence of nausea and Dryness of mouth in the Entonox group. Hemodynamics and respiratory rates were relatively higher in the Entonox group. CONCLUSION: In our study we conclude that the Epidural technique offers better pain relief than Entonox gas. But it must be remembered that Entonox requires no special skill , easy to use, and safe. In many countries it is used by the midwives with one Doctor supervising. We conclude that Entonox is a good, easy to use alternative to the Epidural technique. It can be used in conditions were skilled help is unavailable and where there may be contraindications to the Epidural Technique.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Entonox ; Epidural ; 0.125 % Bupivacaine ; 2gm/ml fentanyl ; Labour Analgesia ; Comparative study.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 22 Apr 2018 15:23
Last Modified: 28 Apr 2018 03:19
URI: http://repository-tnmgrmu.ac.in/id/eprint/7225

Actions (login required)

View Item View Item