Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation

Authors

  • Thomas Anabah University for Development Studies
  • A Olufolabi University for Development Studies and Duke University Medical Centre
  • J Colin Boyd Dalhousie University
  • Ronald Bernard George Dalhousie University

Keywords:

ambulation, intrathecal, low-dose, low-resource, mobility

Abstract

Background: While epidural analgesia for labour pain is standard in high-resource countries, minimal to no analgesia is usually provided in low-resource countries. Intrathecal local anaesthetics provide good pain relief, but the potential impact on ambulation is of concern. Our objective was to determine if a low-dose local anaesthetic combined with an opioid would provide reasonable pain relief, while allowing ambulation in a low-resource setting. Method: This prospective, observational study was conducted at the Tamale Teaching Hospital in Tamale, Ghana. Spinal analgesia was administered to healthy women in labour using a pencil-point 25-G spinal needle at the L3–L4 or L4–L5 interspace, with patients in the sitting position. The intrathecal mixture contained 25 μg of fentanyl, 2.5 mg of bupivacaine and 0.2 mg of morphine. The patient’s ability to ambulate following the administration of a low-dose spinal injection was the primary outcome measured. Pain ratings, blood pressure, nausea, vomiting, pruritus, headaches and foetal bradycardia were also recorded. Results: Three hundred and thirty-two parturients consented to participate. Following spinal injection, 328 women (98.8%) experienced mild to no pain, and 4 (1.2%) moderate pain. The administration of spinal analgesia had no effect on ambulation in 291 (87.7%) patients, and a mild effect in 41 (12.3%) patients. Intrathecal analgesia did not severely limit ambulation in any of the patients. Conclusion: Low-dose intrathecal analgesia can provide effective analgesia for labouring patients in low-resource settings without limiting ambulation.

Author Biographies

Thomas Anabah, University for Development Studies

University for Development Studies Tamale Ghana

A Olufolabi, University for Development Studies and Duke University Medical Centre

MD University for Development Studies Tamale Ghana; and Duke University Medical Centre Durham North Caroline United State of America

J Colin Boyd, Dalhousie University

MSc IWK Health Centre Dalhousie University

Ronald Bernard George, Dalhousie University

MD, FRCPC IWK Health Centre Dalhousie University

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Published

2015-03-16

Issue

Section

Original Research