Randomised Trial on Intravenous Paracetamol versus Intramuscular Nalbuphine as Obstetrics Analgesia in First Stage of Labour

Abstract

Objectives: Labor pain is one of the most extreme pains ever described in the human experience, and different centers may have different standards and available pharmacologic options for managing labour pain. This study aimed to compare the efficacies of intravenous paracetamol and intramuscular nalbuphine for intrapartum analgesia.
Materials and Methods: We conducted a randomized controlled study from April 2019 to March 2020 in the Department of Obstetrics and Gynaecology, Hospital Raja Perempuan Zainab II Kota Bharu, Kelantan. This study involved 80 primigravidae who fulfilled the inclusion criteria and were randomly divided into two groups. The control group received 10 mg intramuscular nalbuphine, whereas the treatment group received 1,000 mg (100 mL vial) of intravenous paracetamol, infused over 15 minutes. Pain assessment before the administration of drugs and at 1 hour, 2 hours, and 3 hours post medication was recorded. Secondary outcomes, such as neonatal outcomes and maternal adverse events, were recorded.
Results: Demographic and clinical data between these two groups were similar. The mean pain score for the control and treatment groups before medication administration was 6.76 and 6.66, respectively. The mean pain score was 5.06 in the control group and 6.09 in the treatment group at 1-hour post medication, 6.19 and 6.89 at 2 hours post medication, and 7.51 and 7.57 at 3 hours post medication, respectively. No statistically significant difference in the mean pain score was found between the groups. However, more maternal adverse events were seen in the control group. No neonatal adverse events were reported in both groups.
Conclusion: Intravenous paracetamol showed no difference in intrapartum analgesic effect compared to intramuscular nalbuphine. However, in this study, we found out it has far fewer maternal adverse events.