Single-dose intrathecal analgesia: a safe and effective method of labor analgesia for parturients in low resource areas

Background
Epidural analgesia is often said the gold standard of the labor analgesia. But in the areas where the availability of epidural catheters, multiparameter monitors, trained staff is scarce, we need to rethink for single-dose intrathecal analgesia as an alternate yet effective method to provide labor analgesia. The combination we chose for single-shot spinal was heavy bupivacaine 2.5 mg + fentanyl 25 μg + morphine 250 μg, so as to provide an optimal time period of analgesia and lesser need for supplemental analgesics.
Methods
The prospective open-label study was conducted on 100 parturients. Group S ( = 50) received intrathecal injection of 0.5 ml of heavy bupivacaine (2.5 mg) and 0.5 ml of fentanyl (25 μg), and 1 ml of preservative free morphine (250 μg/ml) was given (total volume of 2 ml) using 26 G Quincke spinal needle. Group C ( = 50) were managed according to the institutional protocol of programmed labor for normal vaginal delivery. The duration of analgesia, VAS score, safety and side effects, and progress of labor was noted and compared.
Results
The progress of labor, mode of delivery, and fetal parameters was similar in both the groups. But the parturients in the group S had lower VAS score with a pain-free period of 238.96 ± 21.88 min, without any noted side effects.
Conclusion
Single-dose intrathecal analgesia with heavy bupivacaine 2.5 mg + fentanyl 25 μg + morphine 250 μg can be used efficaciously covering the complete duration of labor in both primigravida and multigravida with no increase in instrumental delivery or C-section rate or other side effects.
Trial registration
Institutional Ethics Committee, Indira Gandhi Medical College, Shimla. Number: ECR/533/IST/HP/2014. Registered on 12 August 2017