Obstetric Anesthesia I.V. Paracetamol as an Adjunct to Patient-Controlled Epidural Analgesia With Levobupivacaine and Fentanyl in Labour: A Randomized Controlled Study

Abstract

The purpose of this study was to explore the role of intravenous (IV) paracetamol in intrapartum pain relief. This randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital in India assessed optimization of pain control through use of IV paracetamol as an adjunct analgesic agent during labor. Two groups (n = 40 each) of parturients (18–35 years old) with spontaneous onset of labor at term (37–42 weeks’ gestation), cervical dilatation of 5 cm, and a single live fetus in cephalic presentation were randomized. They then received either 1000 mg (100 mL) IV paracetamol or 100 mL normal saline 30 minutes before epidural placement. All 80 patients then received 10 mL of epidural levobupivacaine 0.1% with 2 μg/mL fentanyl, followed by continuous epidural infusion of 6 mL/h with a patient-controlled epidural-administered bolus of 5 mL of the same drug with a lockout interval of 12 minutes. It was found that IV paracetamol reduced epidural fentanyl and levobupivacaine use with similar pain scores. Both the hourly mean drug consumption and the mean number of boluses were markedly lower in the paracetamol group. The primary outcomewas mean hourly drug consumption, whichwas significantly lower in the paracetamol group (7.03 [SD, 0.83]mL; range, 5.77–8.75 mL) as compared with the placebo group (8.12 [SD, 1.34]mL; range, 6.00–11.70 mL; P < 0.001). There was also a lower total number of boluses in the paracetamol group (mean, 1.00 [SD, 0.93]; interquartile range, 0–2) than in the placebo group (mean, 1.43 [SD, 0.90]; interquartile range, 1–3; P = 0.036). These findings support the use of paracetamol in labor analgesia. The use of IV paracetamol as an adjunct to a labor analgesia regimen is safe and significantly reduces patient-controlled epiduraladministered local anesthetic/opioid consumption.