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

• Published in: Archives of gynecology and obstetrics 2023-03, Vol.307 (3), p.755-762
• Main Authors: Monisha, N., Poomalar, G. K.
• Format: Article
• Language: English
• Subjects: Acetaminophen - adverse effects; Analgesia; Analgesics; Analgesics, Opioid; Childbirth & labor; Double-Blind Method; Endocrinology; Female; Gynecology; Human Genetics; Humans; Infant, Newborn; Labor Pain - drug therapy; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Pain; Pain, Postoperative - drug therapy; Pregnancy; Tramadol - adverse effects
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-022-06585-2

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).