Comparison of PCIA with tramadol and combined spinal-epidural analgesia +PCEA with ropivacaine and fentanyl for labor analgesia

Objective To evaluate the analgesic efficacy and safety of patient controlled intravenous analgesia (PCIA) with tramadol for labor analgesia as compared with combined spinal-epidural analgesia (CSEA) + patient controlled analgesia (PCEA) with ropivacaine and fentanyl. Methods Eighty ASA Ⅰ - Ⅱ full term primigravidae in active labor (at 2 ～ cm cervical dilation) who had a single fetus with vertex presentation and were expected to have a vaginal delivery were randomly divided into 3 groups: 1 control group received no analgesia ( n = 30), Ⅱ group A received CSEA + PCEA with ropivacaine and fentanyl ( n = 30) and Ⅲ group B received PCIA with tramadol (n = 20) . In group A CSEA was performed at L2-3. Ropivacaine 2.5 mg and fentanyl 5 mg were injected intrathecally. A catheter was then advanced 4 cm into epidural space cephalad for PCEA with a mixture of 0.1% ropivacaine with fentanyl 5μg·ml-1 (background infusion 4 ml·h-1 , demand bolus 4 ml with a 15 min lockout interval). In group B the loading dose of tramadol was 1 mg·kg-1 followed by background infusion of 0.75% tramadol at a rate of 2 ml·h-1 (demand bolus 2 ml with a 10 min lockout interval and a total dose limit of 500 mg) . The intensity of pain was evaluated by patients using VAS and motor function was assessed using modified Bromage score. The vital signs (BP, HR, SpO2), fetal heart rate, labor process, mode of delivery, Apgar score of neonates and side effects of analgesia were recorded. Results Good analgesia was achieved with high patient satisfaction in group A (96.7%) and B (95%) as compared with control group, but there was no significant difference in VAS score between group A and B. The onset time of analgesia was significantly shorter in group A (2.4 ± 1.2) min than that in group B (5.3 ± 2.7) min ( P 0.05). Apgar score was higher in group A and control group than that in group B (P 0.05). The duration of second stage of labor was longer in group A (67 ±51) min than that in group B (41±20) min and control group (44 ± 21) min ( P 0.05) . The rate of cesarean section was significantly higher in control group (16.7% ) than that in group A (3.3% ) and B (5.0% ), but the difference between group A and B was not statistically significant. There was no significant difference in vital signs, fetal heart rate, degree of motor block and uterine contraction among the 3 groups. Conclusion CSEA + PCEA with ropivacaine and fentanyl is safe and effective for labor analgesia and is the technique of choice. PCIA with tramadol is a useful alternative if the parturient refuses or is not indicated for combined spinal-epidural analgesia, but the analgesia is less satisfactory and the potential fetus depression is a problem.