Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor

Objectives: To compare analgesic efficacy of intramuscular opioids: meperidine and tramadol with epidural analgesia. Methods: One hundred and twenty-eight term nulliparous women with singleton pregnancy and vertex presentation were randomized to receive either epidural (n = 43), meperidine (n = 39) or tramadol (n = 44). A visual analog scale (VAS) was used to assess the severity of pain. The parameters analyzed were analgesic efficacy, effect on labor, other maternal side effects, perinatal outcome and maternal satisfaction. Results: Median VAS scores following first dose were 0 (0-5), 5 (3-8) and 5 (3-8) in epidural, meperidine and tramadol groups, respectively. Ninety percent of women rated analgesia as good to excellent in the epidural group as compared with 72% of women in the meperidine group and 65% in tramadol group. However, epidural caused a significant prolongation of first (P < 0.05) and second (P < 0.01) stage of labor with an increased number of operative deliveries (27% in the epidural, 7.6% in the meperidine, and 11.4% in the tramadol groups, P < 0.05). In the epidural group 40% women had urinary retention and 16% had motor weakness, whereas sedation was the only side effect seen in the meperidine (41%) and tramadol groups (9%). Respiratory depression was noted among three neonates in the meperidine group, two in the tramadol group and none in the epidural group. Conclusions: The analgesic efficacy and maternal satisfaction is better with epidural analgesia than with opioids. Analgesia provided by meperidine and tramadol is comparable and approximately 50% of women rated the analgesia as good. Meperidine is better in the second stage than tramadol. Hence in developing nations where availability of facilities is the main limiting factor, intramuscular opioids can be considered suitable alternatives. © 2003 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved.