Efficacy of oral paracetamol for sparing the dosage of levobupivacaine-fentanyl combination in patient-controlled combined spinal-epidural analgesia in labouring parturients

Labour pain is the frequently described as the most severe pain that a woman will experience during her lifetime. Neuraxial analgesia is the only technique that can completely relieve the pain of labour and is gold standard for labour analgesia. One of the most popular and effficient method of pain relief is the epidural analgesia tenchnique done by placing a catheter in epidural space. A better option from among the preferred epidural anaesthesia is the use of patient controlled epidural analgesia(PCEA) for labour and delivery. Combined spinal-epidural(CSE) analgesia has become widely popular alternative to low dose epidural analgesia for labour. Low concentrations of bupivacaine provide excellent analgesia without significant motor block. Levobupivacaine has been increasingly used because of its safer pharmacological profile. Use of fentanyl in labour analgesia is not associated with side effects like drowsiness, nausea, respiratory depression in neonates reported in use of other systemic opiods as pethidine, tramadol, remifentanyl. Injection paracetamol has been used as an adjunct to analegsia in number of studies in different surgical settings. However there is only one study of intravenous paracetamol used as an adjunct to intrapartum analgesia drug. It has been seen that overall bioavailability of oral paracetamol is equivalent to intravenous paracetamol. Therefore the aim of the present study is the evaluate the efficacy of oral paracetamol as an adjunct and dose sparing effect on total consumption of levobupivacaine and fentanyl combination in labouring parturients using PCEA.