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Comparison of intravenous paracetamol infusion versus intramuscular tramadol as labor analgesia: a randomized control trial

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Labor pain is one of the most agonizing pains experienced by all delivered women. Many pharmacological agents used in labor analgesia require intense monitoring facilities, which are not available in routine obstetric practice in low-resource settings. This study aimed to compare the efficacy of intravenous (IV) paracetamol and intramuscular (IM) tramadol on labor pain relief, labor progression, and maternal and neonatal outcomes.

Methods

This randomized drug trial was carried out on 110 women divided into two groups. Group A women received 1000 mg of IV paracetamol, and Group B women received 100 mg of IM tramadol during the active phase of labor. Pain intensity was assessed by the Visual Analogue Scale (VAS) at intervals till 120 min of delivery. The maternal and neonatal outcomes were recorded.

Results

There was a statistically significant fall in pain score till 180 min of drug administration in the paracetamol group and 120 min in the tramadol group. At 180 min and 240 min, paracetamol is more effective than tramadol (p value 0.004 at 180 min and 0.0119 at 240 min). There were significantly low pain score levels at 60 min of delivery in the paracetamol group (p value—0.004). Nausea and vomiting were significantly higher in the tramadol group (p value 0.000013).

Conclusion

Compared to IM tramadol, IV paracetamol has a longer duration of action and fewer maternal side effects, making it suitable for parenteral analgesia in labor. Due to a better safety profile, there is no need for intense maternal and fetal monitoring with IV paracetamol.

Trial registration

Clinical Trials Registry—India (CTRI registration number—CTRI /2019/05/019244).

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References

  1. Abdollahi MH, Mojibian M, Pishgahi A, Mallah F, Dareshiri S, Mohammadi S et al (2014) Intravenous paracetamol versus intramuscular pethidine in relief of labour pain in primigravid women. Niger Med J 55(1):54–57

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pita CP, Pazmiño S, Vallejo M et al (2012) Inhaled intrapartum analgesia using a 50–50 % mixture of nitrous oxide–oxygen in a low-income hospital setting. Arch Gynecol Obstet 286:627–631. https://doi.org/10.1007/s00404-012-2359-6

    Article  CAS  PubMed  Google Scholar 

  3. Aimakhu CO, Saanu OO, Olayemi O (2017) Pain relief in labour: a randomized controlled trial comparing intramuscular tramadol with intramuscular paracetamol at the university college hospital, Ibadan Nigeria. Trop J Obstet Gynaecol 34(2):91–98

    Article  Google Scholar 

  4. Das BP, Ali J, Baruah A (2016) Comparative study between intravenous paracetamol and intramuscular tramadol as labour analgesic. Int J Sci Res 5(10):1675–1679

    Google Scholar 

  5. Leppink J, O’Sullivan P, Winston K (2017) Are differences between groups different at different occasions? Perspect Med Educ 6:413–417. https://doi.org/10.1007/s40037-017-0380-y

    Article  PubMed  PubMed Central  Google Scholar 

  6. Makkar KJ, Jain K, Bhatia N, Jain V, Mal Mithrawal S (2015) Comparison of analgesic efficacy of paracetamol and tramadol for pain relief in active labour. J Clin Anesth 27(2):159–163

    Article  Google Scholar 

  7. Lallar M, Anam HU, Nandal R, Singh SP, Katyal S (2015) Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labor analgesic. J Obstet Gynaecol India 65(1):17–22. https://doi.org/10.1007/s13224-014-0556-x

    Article  CAS  PubMed  Google Scholar 

  8. Elbohoty AE, Abd-Elrazek H, Abd-El-Gawad M et al (2012) Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labour. Int J Gynaecol Obstet 118(1):7–10

    Article  CAS  PubMed  Google Scholar 

  9. Viegas OA, Khaw B, Ratnam SS (1993) Tramadol in labour pain in primiparous patients A prospective comparative clinical trial. Eur J Obstet Gynecol Reprod Biol 49(3):131–135

    Article  CAS  PubMed  Google Scholar 

  10. Kashif S, Hamid M (2016) Efficacy of intravenous paracetamol on pressor response in patients undergoing cesarean section under general anesthesia. J Anesthesiol Clin Pharmacol 32(2):210–213

    Article  CAS  Google Scholar 

  11. Jain S, Arya VK, Gopalan S, Jain V (2003) Analgesic efficacy of intramuscular opioids versus epidural analgesic in labour. Int J Gynecol Obstet 83(1):19–27

    Article  CAS  Google Scholar 

  12. Kuti O, Faponle AF, Adevemi AB, Owolabi AT (2008) Pain relief in labour: a randomized controlled trial comparing pentazocine with Tramadol. Nep J Obstet Gynaecol 3:14–18

    Article  Google Scholar 

  13. Pandya ST (2010) Labour analgesia: recent advances. Indian J Anaesth 54(5):400–408

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kellow SY, Ali SMM (2012) Effect of pethidine versus tramadol on labour pain in primiparous women. JSMC 2:17–22

    Article  Google Scholar 

  15. Headley J, Northstone K, Simmons H, Golding J, ALSPAC Study Team (2004) Medication use during pregnancy: data from the avon longitudinal study of parents and children. Eur J Clin Pharmacol 60(5):355–361

    Article  CAS  PubMed  Google Scholar 

  16. Werler MM, Mitchell AA, Hernandez-Diaz S, Honein MA (2005) Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol 193:771–777

    Article  PubMed  Google Scholar 

  17. Gupta K, Mitra S, Kazal S, Saroa R, Ahuja V, Goel P (2016) IV paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour: a randomized controlled study. BJA 117(5):617–622. https://doi.org/10.1093/bja/aew311

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank all the participants of the trial. We would also like to extend our thanks to statisticians from the community medicine department, who performed computer-generated random sequence allocation, and maternity assistants, staff nurses, and registrars on duty in the labor room who helped in collecting study outcomes.

Funding

The authors have not disclosed any funding.

Author information

Author notes

  1. N. Monisha

    Present address: Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education, Karaikal, India

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Puducherry, 605107, India

    N. Monisha & G. K. Poomalar

Authors
  1. N. Monisha
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  2. G. K. Poomalar
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Contributions

MN: project development, recruitment of participants, data collection, and manuscript writing. GKP: project development, manuscript writing, and manuscript editing.

Corresponding author

Correspondence to G. K. Poomalar.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval and clinical trials registry

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by our Institute Ethics Committee (SMVMCH-ECO/AL/135/2018) and registered with Clinical Trials Registry—India (CTRI registration number— CTRI /2019/05/019244).

Publication consent

The authors affirm that publication consent has been received from all the participants.

Data citation

G K Poomalar (2022), “Comparison of intravenous paracetamol infusion versus intramuscular tramadol as labor analgesia—a randomised control trial”, Mendeley Data, V1, https://doi.org/10.17632/2gngzpwfbm.1.

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Monisha, N., Poomalar, G.K. Comparison of intravenous paracetamol infusion versus intramuscular tramadol as labor analgesia: a randomized control trial. Arch Gynecol Obstet 307, 755–762 (2023). https://doi.org/10.1007/s00404-022-06585-2

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  • DOI: https://doi.org/10.1007/s00404-022-06585-2

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