الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The most significant pain likely to be experienced by woman is labor pain which depends on woman interpretation of labor stimuli and this is different from one woman to another. Pain during the first stage of labor is visceral pain originates in the uterus and cervix and it is produced by uterine muscle hypoxia, lactic acidosis, distention of the lower uterine segment, stretching of the ligaments and pressure on the bony pelvis, it is mediated through the afferent nerve supply of the uterus via the sympathetic nerve, which finally reaches the T10-L1 segment of the spinal cord . Safe and effective labor analgesia is an important part of obstetric care. In response to the need for effective labor management, this prospective randomized comparative study was done to detect the effectiveness IV injection of Pethidine, IV injection of Nalbuphine and IV infusion of Paracetamol. The trial was limited only to women with full-term uncomplicated pregnancies admitted in spontaneous labor presenting in the first stage of labor with adequate pelvis, single mature fetus, vertex presentation, engaged head and 3-6cm cervical dilatation. Parturient with any element of exclusion criteria were excluded from the study In this study there were no significant difference between the three groups concerning age, gestational age , parity, cervical dilatation. (P = 0.574). In the study there was significant pain reduction as recorded by VAS at 15minutes ,1hour and 2 hours in the three groups but it was more reduction in VAS in Pethidine group than Nalbuphine group and Paracetamol group. After 2 h there was significant pain reduction as recorded by VAS in pethidine and Nalbuphine groups but there was more reduction in VAS in Pethidine group than Nalbuphine group. After 3 h there was significant pain reduction as recorded by VAS in Pethidine group and Nalbuphine group but not in Paracetamol group. Regarding the need for additional analgesia, in Pethidine group and Nalbuphine group there was 7 women in both groups needed additional analgesia (23.3%), while in Paracetamol group 15 women (50%) need additional analgesia( the most need for additional analgesia) with significant difference between the three groups (P = 0.039). Regarding fetal side effects, in Paracetamol group there was no fetal side effects could be detected while in Pethidine group there were 4 cases of fetal bradycardia and in Nalbuphine group there were 5 cases of fetal bradycardia with insignificant difference among the three groups (P = 0.079). Regarding neonatal side effects, in Paracetamol group there was no neonatal side effects could be detected while in Pethidine group there were 7 cases of neonatal side effects in the form of decreased APGAR score and poor suckling and in Nalbuphine group there were 10 cases of neonatal side effects in the form of decreased APGAR score and poor suckling with significant difference among the three groups (P = 0.079). Regarding neonatal side effects, in Paracetamol group there was no neonatal side effects could be detected while in Pethidine group (36.7%) of cases had maternal side effects in the form of dizziness ,tachycardia , hypotension , blurred vision, dyspnea, dry mouth while in Nalbuphine group there were (43.3%) of cases had maternal side effects, in paracetamol group only one case (3.3%) had maternal side effects with significant difference among the three groups (P = 0.001). Vaginal delivery occurred in 20 patients (66.7%) of cases in both Pethidine group and Nalbuphine group while it occurred in 28 patients (93.3%) of cases in paracetamol group with insignificantly difference (P = 0.989). Duration from administration of labor analgesia till delivery was 8.2h in Nalbuphine group and it was 8 h in Pethidine group insignificant difference between both groups (P = 0.225) while in paracetamol group it was 6 h with significant difference (P <0.001) in favor of Paracetamol group which experienced delivery after earlier duration than Nalbuphine and Pethidine groups. In both Nalbuphine group and Pethidine group (13.3%) of cases expressed as excellent analgesia, good in (26.7%).While in Paracetamol group only one patient expressed as excellent analgesia (3.3%) and 9 patients (30%) expressed as good analgesia with insignificant difference between the three groups (P = 0.579). In this study, Apgar score was significantly different among the three groups at 1 min and at 5 min (P = 0.001). Apgar at 1 min and at 5 min was significantly increased in Paracetamol group than Nalbuphine group and Pethidine group (P2 = 0.002 and P3 = 0.003) and was insignificantly different between Nalbuphine group and Pethidine group.