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Does Oral Acetaminophen Reduce Neuraxial Analgesic Requirement during Labor
Abstract Number: S-17
Abstract Type: Original Research
Background: Patient controlled epidural analgesia is commonly used for labor analgesia; however patients often require additional dosing despite a basal infusion and self-administered boluses. As the amount of epidural local anesthetic increases, their use can be complicated by maternal hypotension and motor block. Acetaminophen has been shown to be an effective adjuvant for postoperative analgesia and safe for use in pregnancy. Our hypothesis is that administration of acetaminophen during labor will reduce the amount of neuraxial analgesic drug required in a double-blind prospective control study.
Methods: After IRB approval, 60 parturients with cervical dilation <5cm requesting epidural labor analgesia were planned to be consented and randomized to receive either 1 gram acetaminophen(ACT) or placebo(PLAC), administered orally every 6 hours. This was initiated at time of epidural placement and continued until time of delivery. Epidural analgesia was performed and tested as in usual manner. EPCA setting was 6mL/hr basal infusion, 5 mL demand dose with 10 mins interval and hourly limit of 30 mL/hr of 0.125% bupivacaine with 2ug/mL fentanyl. Top-up doses were administered as needed, consisting of either 0.25% bupivacaine, or 2% lidocaine. The primary outcome measure was epidural analgesic consumption per hour. Secondary outcome data were frequency of top-ups, VAS pain scores, vital signs, including temperature, side effects, and neonatal outcomes.
Results: 23 of 60 patients were enrolled (11-ACT and 12-PLAC, remainder to be enrolled prior to SOAP meeting). Demographics were not different between groups. Average duration from initiation of epidural analgesia to delivery was 8.1 hrs (ACT) and 7.9 hrs (PLAC) and 1 patient delivered by cesarean. Preliminary results showed that the total amount of analgesic consumption was 18.9±5.6 and 20.9±4.0 mL/hr equivalence of 0.125% bupivacaine with 2ug/mL fentanyl, respectively for ACT and PLAC groups. Secondary outcomes were not significantly different between groups (Table 1).
Conclusion: Preliminary data suggest that adding oral acetaminophen as an adjunct for labor analgesia reduces epidural analgesic requirement by 10%, though it has not reached statistical significance with 23 of 60 patients. This study assesses the benefit of multimodal approach to labor analgesia; such a combination may improve the quality of pain relief, patient satisfaction, and reduce the amount of local anesthetics and associated side effects.