Abstract :
Childbirth is an apogee event in a family full of beliefs and traditions which can be either scientific or cultural and personal. Labour (the process of childbirth) is the most excruciating event for the majority of women. The pain experienced during labour puts stress on the maternal body in terms of an increase in mechanical workload, increasing the demand for oxygen and the resulting hyperventilation leads to catecholamine surge with resultant greater uterine contractility and uterine vasoconstriction, thereby hypoperfusion of fetoplacental unit produces foetal hypoxia leading to acidosis. All these consequences due to labour pain can be blunt by providing adequate labour analgesia1. In modern labour room practice, neuraxial analgesia is the most reliable, safer and effective method. Therefore, considered to be the gold standard technique in providing better pain relief during labour when compared to other pain relief approaches. Epidural analgesia (EA) is very extensively used due to its well-recognised pain relieving property2 . It provides significantly effective analgesia. It helps in counteracting the untoward effects of catecholamine increase by blunting the hemodynamic changes and maintaining the maternal cardiac output, heart rate and blood pressure throughout the labour. Combined-spinal epidural analgesia (CSEA) technique combines the advantages of subarachnoid analgesia also, such as speed of onset and reliability of block with the flexibility of extending analgesia, provided by the presence of an epidural catheter and avoids their particular disadvantages3 .The addition of lipophilic opioids to local anaesthetic for neuraxial analgesia increases the duration of sensory block4 . It doesn’t depress neonatal respiration or adversely affect neurobehavioural scores and other indices of neonatal welfare5 . Labour analgesia with both techniques are considered to be safe and very effective6 . Pregnant patients are more prone to harmful effects of local anaesthetics due to ascent at higher level. Hence techniques which can decrease the dose are very beneficial, so in this study we avoided local anaesthetic in spinal, used only opioid and in epidural we used low dose local anaesthetic in form of 0.1% ropivacaine. So, this study was designed to compare the efficacy and safety of these two techniques with primary aim of onset of analgesia, while secondary aims were to observe amount of local anaesthetic consumption, the quality of analgesia, any potential side effects and maternal satisfaction.
Keyword :
Urine Albumin, Maternal Age, Ropivacaine, Intrathecal Injection