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INTRAVENOUS ACETAMINOPHEN AS AN ADJUNCT TO PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH LEVOBUPIVACAINE AND FENTANYL IN LABOR: A RANDOMIZED CONTROLLED STUDY
Abstract Number: T-27
Abstract Type: Original Research
BACKGROUND: To evaluate the effect of intravenous infusion of acetaminophen on the average hourly consumption of levobupivacaine and fentanyl combination given as patient-controlled epidural analgesia (PCEA) in laboring parturients.
METHODS: In this randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital, 80 parturients were randomly assigned to two groups of 40 each to receive either 1000mg (100ml) i.v. acetaminophen or 100ml normal saline as placebo 30min before the procedure. After insertion of the epidural catheter all patients received 10ml of levobupivacaine 0.1% with 2μg/ml fentanyl, followed by continuous background epidural infusion of 6ml/h of with a provision of patient-controlled bolus 5ml of same drug with a lock-out interval of 12min.
The primary outcome was hourly average consumption of levobupivacaine and fentanyl mixture. Secondary outcomes included pain score, sensory and motor block characteristics, hemodynamic parameters of mother, duration of second stage of labor, mode of delivery, Apgar scores, fetal heart rate and adverse effects.
RESULTS: The average hourly drug consumption in the Acetaminophen group was significantly lower as compared to Placebo group (7.035 ± 0.83 ml/h vs. 8.124 ± 1.34 ml/h; p<0.05). The number of boluses taken were also significantly less in Acetaminophen group (1.00 ± 0.93 vs. 1.43 ± 0.90; p<0.05).
CONCLUSION: Use of 1000mg i.v. acetaminophen 30min before the procedure significantly decreases the average hourly drug consumption as well as number of boluses taken through the epidural route. Thus i.v. acetaminophen is a safe and effective adjunct to PCEA in labor analgesia.