Tamadol Injection versus Epidural Analgesia in Controlling Labor Pain

Since epidural analgesia was introduced four decades ago for pain relief in labor, controversy has persisted about its effect on the labor process; so, systemic opioid analgesics may be good customary for intrapartum pain control. Aim of the Study To compare efficacy of tamadol injection as opioid analgesic versus epidural analgesia on governing labor pain, the progress of labor and labor outcomes (maternal and fetal). Methodology One hundred and fifty Pregnant women primigravida with gestational age between 37 to 41 weeks (confirmed by early ultrasound) with vertex presentation without any risk factors, in established labor (cervical dilation >3 cm with regular uterine contraction) were included and divided into two groups in this study viz. tramadol group (A) and epidural group (B). Subjects of group (A) received 1mg/kg tramadol intramuscularly bolus and 100mg in 500 ml Ringer lactate at the rate of 8-24 drops/min and those of group (B) received Epidural ? 0.125% bupivacaine with fentanyl 5 mcg/ml 10-15 ml repeated hourly throughout labour and continued until birth. Pain relief was assessed by visual analogue scale of 10 (scores ranging from no pain to unbearable pain) before the administration of the drug at 0, 5min, 10min, 15min, 30min, 1 hr and every 2 hr until full dilatation. Maternal and neonatal out comes were determined. Results Total number of patients was one hundred and fifty, all were primigravida. The mean age of group A was 22.81±1.89 years and 23.23 ±1.28 in group B. Mode of delivery was spontaneous vaginal in 64 patients (85.3 %) in group A and 53 patients (70.6 %) in group B while Instrumental vaginal delivery in 6 patients (8 %) of group A and 13 Patients (17.3 %) of group B. Cesarean section in 5 patients (6.6 %) of group A and 9 patients (12 %) of group B. At one minute majority of the babies of group A had mean Apgar score 8.70±0. 52 versus 8.65±4.1 at group B. At 5 minute; 9.40±0.33 versus 9.54±0.23. There were no significant differences. In tramadol group, pain relief was excellent in 13.3%, good in 30.6% and average in 54.6% versus 29.3%, 48% and 22.6% in epidural group. In both the groups there was no significant effect on duration of 1st & 3rd stage of labor but Second stage of labor was prolonged in the epidural group. Conclusion Epidural anaesthesia and tramadol provided excellent pain relief in majority of the patients but, as Tramadol could be considered as an alternative to epidural analgesia in lower source settings of the developing nations as administration is easy.