Subarachnoid analgesia in labor: bupivacaine/fentanyl vs. pethidine

Abstract

Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship.
Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods.
Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 %, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used.
Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, (Z= 6.0 significant); heart rate averages between 80 and 88 beats per minute, (Z= 1.94 not significant); partial oxygen saturation with an average of 99.2 %. In 46.74 % (43 cases) the time of onset of analgesia was short (Z= 8.47), being good in 100% of the cases (Z= 6.89 significant), with vigorous newborn in 100 % (Z= 10.25 significant). The evolution was satisfactory in 48.19 % of the patients. They presented pruritus 8.69 %. In group B, there was arterial hypertension in 2.17 % of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 % and it was good in 40.22 %. These patients showed less satisfaction (41.30 %).
Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor.