A COMPARISON OF TRAMADOL AND PETHIDINE ANALGESIA ON THE DURATION OF LABOR AND PREGNANCY OUTCOME
Keywords:
Pethidine. pain relief, tramadol, delivery, Apgar scores.Abstract
The ideal obstetric analgesia would be one that would relieve the pain of childbirth without affecting the strength of uterine contractions. Many countries still use intravenous opioids for this purpose.
Objective: To evaluate and compare the effect of intramuscular pethidine and tramadol on duration of labour, pain relief and delivery. Methods: A prospective comparison study was done on 175 women with full-term pregnancies in the middle of labour, who were randomly allocated to two groups. One group was administered 50 mg of pethidine intramuscularly, and the other group was given 175 mg of tramadol intramuscularly. Secondary outcomes were labour time, analgesic effects, maternal side effects, delivery method and neonatal Apgar scores.Results: The average duration of labour was significantly different between the two groups. Labour length was shorter in the tramadol group in both the first stage (124 minutes in the pethidine group against 99 minutes in the tramadol group; P=0.0001) and the second stage (26 minutes in the pethidine group versus 25 minutes in the tramadol group; P=0.0001). Pain ratings and visual analogue scores were statistically significant between the two groups 10 minutes and 1 hour after drug administration, with scores of 5 in the pethidine group versus 7 in the tramadol group (P=0.0001); during the first stage, the scores were 7 versus 8 (P=0.0001), and in the second stage, they were 8 versus 9 (P=0.00015 in the pethidine group versus 7 in the tramadol group; P=0.0001). Scores over the first stage were 7 versus 8 (P=0.0001) and 8 versus 9 (P=0.0001) in the second stage. Pain in women in the pethidine group was lower in comparison to the tramadol group. Significantly different rates of nausea and vomiting (40% vs 22%) and fatigue (31% vs 20%) were found between the tramadol and pethidine groups. The groups exhibited comparable Apgar scores at 1 min (6 vs. 8; P = 0.01); however, there was a significant difference at 5 min between the pethidine group and the control group (9 vs. 9; P = 0.2).Conclusion Both agents may have minor analgesic effects during the first stage of labour.
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