A Randomised Clinical Trial on Analgesic Efficacy of Intravenous Paracetamol as an Adjunct to Patient Controlled Epidural Analgesia with Ropivacaine and Fentanyl in Labour

Introduction: Intravenous (i.v.) paracetamol is considered as an effective and safe analgesic agent in labouring women, but its effect on patients already receiving epidural analgesia is not well documented. Aim: To know whether i.v. paracetamol reduces epidural local anaesthetic opioid combination consumption in labour by virtue of its analgesic effects. Materials and Methods: The present double blind, randomised clinical study was conducted on 88 singleton term pregnant women in active labour. Half of these women (n=44, Group P) received 1000 mg (100 mL) i.v. paracetamol and rest (n=44, Group C) received 100 mL normal saline as placebo (n=44). Thirty minutes later all women received 10 mL of ropivacaine 0.125% with 2 mu g/mL fentanyl through epidural catheter, followed by continuous background epidural infusion of 5 mL/h with a provision of patient controlled bolus 5 mL of same drug with a lock-out interval of 15 minutes. The primary outcome was hourly mean consumption of epidural drug in mL. Results: The hourly mean drug consumption in the paracetamol group was significantly lower as compared to control group (7.75 +/- 0.93 mL/hr vs. 8.23 +/- 0.99 mL/hr; p=0.022). The mean number of boluses needed by parturient were also significantly less in the paracetamol group ( 0.58 +/- 0.66 vs. 1.02 +/- 0.82; p=0.005). Pain relief after epidural placement was adequate in both groups with similar Visual Analogue Scale (VAS) values without significant intergroup differences. Conclusion: It can be concluded that 1000 mg i.v. paracetamol is a safe and effective adjunct to Patient Controlled Epidural Analgesia (PCEA).