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Upsala Journal of Medical Sciences. 2011; 116: 252–257

ORIGINAL ARTICLE

Comparison of epidural tramadol-ropivacaine and fentanylropivacaine for labor analgesia: A prospective randomized study

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YUNXIA FAN1, MUHUO JI2, LINA ZANG1, WENHUI WANG1, QI YIN1, JIAN XU1 &
JIANJUN YANG2
1Department of Anaesthesiology, Jintan Hospital, Jiangsu University, Changzhou, P. R. China, and 2Department of
Anaesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, P. R. China

Abstract
Background. To test the hypothesis that 5 mg/mL tramadol is superior to 3 mg/mL fentanyl when combined with 0.125%
ropivacaine in parturients undergoing labor during epiduralanalgesia.
Methods. Sixty-one parturients undergoing labor selected for delivery with epidural analgesia were randomized into two groups:
Group tramadol (0.125% ropivacaine plus tramadol 5 mg/mL) and Group fentanyl (0.125% ropivacaine plus fentanyl 3 mg/
mL). Hemodynamics, rate of cesarean delivery, sensory block level, Bromage motor scale scores, instrument-assisted delivery,
oxytocin use,visual analog scale (VAS) scores, Apgar scores, umbilical cord artery gas analysis, and maternal sideeffects including nausea, vomiting, pruritus, urinary retention, shivering, hypotension, and respiratory depression were
recorded.
Results. The two groups had no significant differences with respect to maternal hemodynamics, neonatal heart rate, VAS scores,
rate of cesarean delivery, sensory blocklevel, Bromage motor scale scores, instrument-assisted delivery, oxytocin use,
hypotension, nausea, vomiting, and respiratory depression (p > 0.05). The incidence of pruritus, shivering, and urinary
retention were more commonly observed in Group fentanyl despite there was no significant difference between the two groups.
Umbilical artery pH was significantly lower while PCO2 was higher in Groupfentanyl than Group tramadol (p = 0.003 and
p = 0.026, respectively). Birth-weight, umbilical artery PO2 and base deficit, and Apgar scores at 1 and 5 min were comparable
between the two groups (p > 0.05).
Conclusions. Our observations suggest that tramadol seems to be a safe alternative to fentanyl for labor analgesia due to its
similar analgesic efficacy.

Key words: Analgesia, epidural,fentanyl, labor, tramadol

Introduction
Epidural nerve block is widely used for labor analgesia
because of its effective pain relief, reduced maternal
stress response, improved parturient satisfaction, and
potential ability to provide anesthesia (1). The quality
of analgesiais improved with the combined use of a
local anesthetic and an opioid when combined with
the use of either agent alone.An example of acombination epidural therapy that provides excellent sensory

block with relatively little motor block includes a
co-administration of ropivacaine and fentanyl (2).
However, the side-effects of fentanyl are still of concern
during its use in perioperative period (3).
Tramadol not only binds to opioid m-receptors but
also interacts with the central nervous system by
inhibitingthe withdrawal of noradrenaline and serotonin (4). The unique pharmacological profile of
tramadol makes it an attractive drug for postoperative
pain management. In several preliminary clinical

Correspondence: Dr Jian-Jun Yang, Department of Anaesthesiology, Jinling Hospital, 305 East Zhongshan Road, Nanjing 210002, P. R. China.
Fax: +86-25-84806839. E-mail: yjyangjj@126.com
(Received 11April 2011; accepted 26 June 2011)
ISSN 0300-9734 print/ISSN 2000-1967 online Ó 2011 Informa Healthcare
DOI: 10.3109/03009734.2011.601532

Epidural tramadol and fentanyl for labor analgesia
trials, tramadol has been proved to be a safe and
effective drug for epidural analgesia (5,6).
Hence, the purpose of the present study was to
compare the analgesic and side-effects of two solutions that...