Quest for Labor Analgesia in Second Stage in Resource Poor Setup

Abstract

194Aim: To assess the analgesic effect of pudendal nerve block (PNB) as labor analgesia in the second stage of labor, its effect on the duration of the second stage and to assess any adverse maternal and fetal outcome. Materials and methods:The prospective, randomized, casecontrol study (parallel group trial) was conducted with a total of 110 parturient women. They were randomly allocated to either study group (n = 55) or control group (n = 55). The study was performed after the approval of the institutional ethical committee. All the women recruited for the study were given first stage analgesia. The pain was assessed using the verbal rating scale. In the second stage of labor, the women in the study group were given transvaginal PNB (5 mL of 1% Lignocaine + 5 mL of 0.25% bupivacaine) bilaterally, whereas, in control group, no added analgesia was given. Statistical analysis:Quantitative data were compared using the unpaired t-test and qualitative data was compared using chi square test. p ≤ 0.05 has been taken as the level of statistical significance. The data were analyzed by Statistical Package for the Social Sciences (SPSS) statistical software version 17.0.Results: It was observed that in the second stage of labor, Pudendal Nerve Block produced pain relief in 98.2% women, out of which 14.6% had excellent pain relief and 52.7% had moderate pain relief. This was found to be statistically significant (p < 0.05). The mean duration of the second stage of labor was longer in the study group (29.02 minutes) than in the control group (16.86 minutes) (p < 0.05). There was no significant adverse maternal and fetal outcome. Conclusion:The PNB provides an effective analgesia in the second stage of labor without the major neonatal and maternal morbidity.Clinical significance: The PNB can be provided by obstetricians in any delivery setup, even in low resource settings, without the need for skilled anesthetists.

A Randomized Controlled Trial of Entonox and Oxygen in Labor Analgesia

“…Several routes for labor analgesia have been tried, such as intravenous analgesics, inhalation therapy, acupuncture, pudendal nerve block, and epidural anesthesia. 3,4 However, all the methods should be safe for both the mother and the fetus. Of these, Entonox is an analgesia gas that is a premixed homogenous gas mixture of nitrous oxide and oxygen in the ratio of 50:50 compressed in a cylinder, and it is a noninvasive method of analgesia providing conscious sedation for obstetric purposes.…”