Maternal Satisfaction and Side Effect Profile of Single-shot Spinal Labour Analgesia Using Low-dose Intrathecal Bupivacaine with Opioid Adjuvants
MEM Clement
Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
F Hart *
Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
SO Imasuen
Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
FT Awodesu
Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Maternal satisfaction is an important outcome of labour analgesia, reflecting pain relief and childbirth experience. This study compared maternal satisfaction and side-effect profiles following single-shot spinal labour analgesia using low-dose bupivacaine alone or with opioid adjuvants.
Aim: To compare maternal satisfaction, duration of analgesia, and side-effect profiles following single-shot spinal labour analgesia with low-dose intrathecal bupivacaine alone, bupivacaine with fentanyl, and bupivacaine with fentanyl and morphine.
Methods: A total of 102 ASA II parturients aged 18–45 years in active labour at the University of Port Harcourt Teaching Hospital. Participants received 2.5 mg hyperbaric bupivacaine alone (BO), bupivacaine with 25 µg fentanyl (BF), or bupivacaine with 25 µg fentanyl and 200 µg preservative-free morphine (BFM). Maternal satisfaction, adverse effects, analgesic duration, pain scores, motor recovery and neonatal outcomes were assessed.
Results: Satisfaction with pain treatment was 76.5% in BO, 88.2% in BF and 100% in BFM (p=0.011). Willingness to recommend the technique was 82.4%, 88.2% and 100%, respectively (p=0.045). Mean time to first request for additional analgesia was significantly longer with BFM (239.35±27.29 minutes) than BF (146.78±12.19 minutes) and BO (119.41±15.65 minutes; p<0.001). Pruritus was most prominent in BFM, peaking at two hours, when it occurred in five women (14.7%), compared with one woman (2.9%) in BF (p=0.024). Nausea and vomiting were transient and occurred more frequently in the BO group at selected early time points. No severe respiratory depression or prolonged clinically important motor block was reported. Full motor function was present by 30 minutes. Neonatal outcomes were generally reassuring.
Conclusion: Adding fentanyl and morphine to low-dose intrathecal bupivacaine improved maternal satisfaction and substantially prolonged analgesia.
Keywords: Labour analgesia, maternal satisfaction, single-shot spinal, bupivacaine, fentanyl, morphine, pruritus, obstetric anaesthesia