Effect of butorphanol nasal spray administration on patient cooperativity during labor epidural placement: a single-center randomized controlled trial.

Abstract

Background: Epidural block stands as the prevailing, secure, and efficient approach to labor analgesia. Inadequate maternal cooperation not only hampers anesthesia effectiveness but also may lead to severe consequences, including nerve damage due to positional changes.

Methods: A randomized controlled clinical trial with 200 participants was conducted to compare painless delivery with epidural alone versus a combination of butorphanol nasal spray preceding epidural administration for painless delivery. The objective was to assess the combined approach's efficacy in diminishing maternal pain and enhancing maternal compliance.

Results: Within 8-min post-anesthesia, the combined analgesic group (EXP group) exhibited significantly lower maternal pain intensity scores, improved maternal cooperation, reduced visual analogue scale (VAS) pain, and McGill scores compared to the epidural alone group (CTRL group). No statistically significant differences emerged in 24-h postpartum blood loss, labor duration, or lactation period. Neonatal indicators, including umbilical artery blood PCO2, base excess of extracellular fluid (BE-ecf), weight, and Apgar score, showed no significant differences between the EXP and CTRL groups. However, the EXP group demonstrated a higher umbilical artery blood pH than the CTRL group. The EXP group exhibited significantly higher probabilities of pain intensity scores ≤ 6, maternal cooperation scores ≤ 3, VAS scores ≤ 3 at 6-, 8-, and 10-min post-anesthesia, and McGill scores of 0 compared to the CTRL group.

Conclusion: Butorphanol nasal spray emerges as an effective means to alleviate pain during epidural puncture in labor analgesia, markedly improving maternal anesthesia adherence. This combined analgesic method proves to be a safe and efficacious approach for maternal pain relief during labor.