Comparison of epidural bupivacaine with fentanyl and epidural bupivacaine with dexmedetomidine for labour analgesia: A Randomized control Trial

Abstract

Background: Labor analgesia influences maternal comfort and obstetric outcomes. Bupivacaine-based epidural anesthesia is a standard, yet optimal adjuvants require investigation for improved analgesic efficacy and safety. Objective: This study aimed to compare analgesic effectiveness, maternal satisfaction, and side-effect profiles of epidural bupivacaine-fentanyl versus epidural bupivacaine-dexmedetomidine for labor analgesia in a randomized, controlled, double-blind trial, including neonatal outcomes. Methods: A total120 parturients at Indira Gandhi Institute of Medical Sciences (5 September 2018–4 September 2020) were enrolled in a double-blind, randomized, controlled trial (n=60 per group). Group BF received bupivacaine 0.125% plus fentanyl (2 µg/mL), whereas Group BD received bupivacaine 0.125% plus dexmedetomidine (0.5 µg/mL). Primary outcomes were pain scores; secondary measures included neonatal Apgar scores, maternal satisfaction, and adverse events. Results: Group BF (bupivacaine-fentanyl) reported a mean VAS pain score of 3.2 ± 0.7 at 30 minutes versus 2.8 ± 0.6 in Group BD (p=0.042). The onset of analgesia was faster in Group BD (10.2 ± 1.8 minutes) compared to Group BF (12.5 ± 2.0 minutes; p=0.038). Maternal satisfaction scores were higher in Group BD (88% vs. 76%, p=0.027). Sedation remained mild in both groups. Incidence of hypotension was 12% in BD versus 10% in BF (p=0.712). Neonatal Apgar scores at 1 and 5 minutes were ≥7 in all cases. Overall, dexmedetomidine-enhanced analgesia demonstrated superior efficacy and comparable safety to fentanyl-based regimens. No serious complications occurred. Conclusions: Dexmedetomidine as an epidural adjuvant provided superior analgesia and maternal satisfaction compared to fentanyl, with minimal side effects. These findings support dexmedetomidine’s role as a safe alternative for labor analgesia.