الفهرس 
introductIonOnly 14 pages are availabe for public view
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Abstract
Current obstetric analgesic practice aims to provide effective pain relief while minimizing motor blockade to allow the parturient to actively participate in the birthing experience. In addition, it should have a minimal effect on the fetus or the progress of labor. In absence of motor weakness, there is no functional impairment of balance after epidural analgesia in labouring women and therefore ambulation is safe.
Bupivacaine continues to be the most widely used local anesthetic for epidural labour analgesia because it provides excellent sensory block during labour and delivery.
Fentanyl, a synthetic opioid, when added to bupivacaine potentiates its action thereby reducing the total dose of bupivacaine leading to a reduced incidence of motor block.
In our study, 60 nulliparous labouring women ASAI or II received epidural analgesia and were classified according to the epidural injection into two groups:
Group I: parturients received bupivacaine 7.5 mg with fentanyl 30 µ made up to a total volume of 15 ml with normal saline as an initial bolus then received bupivacaine 5 mg with fentanyl 20 µ made up to a total volume of 10 ml with normal saline every hour.
Group II: parturients received bupivacaine 15 mg with fentanyl 30 µ made up to a total volume of 15 ml with normal saline as an initial bolus then received bupivacaine 10 mg with fentanyl 20 µ made up to a total volume of 10 ml with normal saline every hour.
All parturients were assessed by history taking, clinical examination and routine laboratory investigations. A standardized technique was used where an intravenous infusion of 15 ml/kg lactated ringer was started, 50 mg Ranitiadine hydrochloride and 10 mg metoclopramide were given, maternal baseline condition as regards heart rate, non-invasive mean arterial blood pressure, oxygen saturation and respiratory rate were measured and the epidural technique was performed using loss of resistance technique with the epidural injection of the chosen drug regimen.