COMPARATIVE STUDY BETWEEN TRAMADOL HYDROCHLORIDE- BUPIVACAINE VERSUS FENTANYL- BUPIVACAINE FOR EPIDURAL ANALGESIA DURING lABOR

Abstract

Many women today are well informed of health issues surrounding childbirth, and have clear views about where and how they want to have their baby. Their request is straight forward: to experience delivery actively and naturally as possible with minimal pain as possible.

Regional analgesia especially epidural anesthesia Is considered to be one of the most popular and safe techniques for obstetric anesthesia in our modem practice.

During the first and second stages of labor, epidural anesthesia blunts the increase in the maternal cardiac output, heart .rate and blood pressure that occurs during painful uterine contractions and "bearing down" effort thus reducing myocardial work and oxygen consumption. Epidural analgesia by reducing the maternal secretion of catecholaniines, and maternal hyperventilation prevent the reduction of the fetal arterial oxygen tension and though converts a previously dysfunctional labor pattern to normal.

Opioids are given to increase the efficiency of epidural analgesia and to decrease the dose of the given local anesthetic. Tramadol hydrochloride is a centrally acting agent which has a low affinity for the J..L-opioid receptor and which, by monoaniinergic reuptake inhibition (norepinephrine and serotonin), enhances the antinociceptive effect of the descending inhibitory pathway in the spinal cord.