1. Department of Anesthesiology, ICU and Pain Management, Qena Faculty of Medicine, South Valley University, Egypt.
Background: Fentanyl has been used along with bupivacaine for labor analgesia. Dexmedetomidine may be used to alleviate this pain because it has several analgesic properties, lack of respiratory depression and has a high placental retention. This study was aimed to evaluate the efficacy and safety of combination of IT dexmedetomidine and fentanyl on maternal and neonatal outcomes during labor in comparison to IT dexmedetomidine or IT fentanyl.
Patients and methods: 90 patients were included aged 19-39 years (ASA physical status I-II) with single uncomplicated pregnancy. Patients were randomly divided into three groups: group D: 30 patients were received IT 10 μg dexmedetomidine in 1 ml of normal saline, group F: 30 patients received IT 20 μg fentanyl in 1 ml of normal saline and group DF: 30 patients received IT 5 μg dexmedetomidine plus 10 μg fentanyl in 1 ml of normal saline. Age, weight, height, parity, gestational age, rupture of membrane, cervical dilatation and progress of labor were noted. The time of onset, duration of analgesia, maternal parameters of heart rate (HR), mean arterial blood pressure (MAP) and Visual analog score (VAS) were recorded. Sideeffects of pruritus, nausea and vomiting, hypotension and bradycardia were recorded. Neonatal outcome in terms of mode of delivery, neonatal Apgar score and umbilical artery pH were recorded.
Results: The patient's demographics and labor characteristics were comparable among the studied groups. The dexmedetomidine group and dexmedetomidine and fentanyl mixture group have prolonged duration of analgesia. VAS score was improved in all groups after onset of analgesia. HR and MAP were lowest in dexmedetomidine group than other two groups. The fentanyl group showed significant increase in the adverse effect incidence (pruritus).
Conclusion: Addition of 5 μg intrathecal dexmedetomidine to 10 μg fentanyl prolonged the duration of analgesia. The combination decreases the incidence of side effects in comparison to IT 10 μg dexmedetomidine or IT 20 μg fentanyl alone.
Keywords: Dexmedetomidine, fentanyl, labour analgesia, neonatal