Labour Analgesia When Epidural Is Not a Choice: Tramadol versus Pentazocine

Background. Parenteral opioids, thus, are still popular for pain relief in labor in many countries throughout the world. Aim. To evaluate and compare the efficacy of intramuscular tramadol and pentazocine in the first stage of labor. Method. Sixty-five patients were divided into pentazocine group and tramadol group. Subjects received either 30？mg pentazocine or 1？mg/kg tramadol intramuscularly. Pain was assessed using visual analog scale (VAS) before the administration of the drug, at 1？h, 2？h, 4？h, and at full dilatation. Maternal and neonatal side effects were determined. Results. Analgesic effect of the two drugs was not significantly different. Neither of these analgesics was effective towards the end of the first stage. However, in the tramadol group, the majority of women (55%) rated pain as severe, whereas in the pentazocine group, the majority of women (60%) rated pain as moderately severe. There were not many side effects with either of the drug in the given dosage. Mean injection to delivery interval was significantly shorter in the tramadol group as compared to the pentazocine group. Conclusion. Pentazocine or tramadol can be given for labor pain relief as an alternative to epidural analgesia in resource poor setting. 1. Introduction Pain management during labour is an essential part of good obstetric care. Though this severe pain during labour is not life threatening, it can have neuropsychological consequences. Postnatal depression may be more common when labour analgesia is not used [1]. Pain during labor has also been correlated with the development of posttraumatic stress disorder [2]. It has been proven beyond a doubt that epidural analgesia, when compared with other methods, provides superior analgesia for labor. However there can be situations where either it is not available or it is not feasible. Parenteral opioids, thus, are still popular for pain relief in labor in many countries throughout the world. A recent Cochrane review emphasized that as parenteral opioid drugs are very widely used for labor analgesia, it is important that more research is carried out so that women can make informed choices about these forms of pain relief [3]. Use of parenteral opioids for labour pain relief has been quite common, pethidine being the most commonly used drug in this group worldwide [4]. Studies on pethidine have, however, raised concerns about its adverse effects on the parturient and the newborn. It has been implicated to result in neonatal behavioral and feeding problems up to six weeks after delivery [5]. These concerns about pethidine