“FENTANYL AS AN ADJUVANT TO BUPIVACAINE AND

ROPIVACAINE IN EPIDURAL LABOUR ANALGESIA”

THESIS FOR THE DEGREE OF

M.D.

ANAESTHESIOLOGY

2017-2020

Pt. DEENDAYAL UPADHYAY MEMORIAL HEALTH SCIENCES

AYUSH UNIVERSITY OF CHHATTISGARH,
RAIPUR (C.G.)

DEPARTMENT OF ANAESTHESIOLOGY AND CRITICAL CARE

Pt. J.N.M. MEDICAL COLLEGE &Dr. B.R.A.M. HOSPITAL

RAIPUR (C.G.)

Dr. SOFIYA MEMON

DEPARTMENT OF ANAESTHESIOLOGY AND CRITICAL CARE

Pt. J.N.M. MEDICAL COLLEGE & Dr. B.R.A.M. HOSPITAL

RAIPUR (C.G.)

Certificate
This to certify that the work entitled “Fentanyl as an adjuvant to
bupivacaine and ropivacaine in epidural labour analgesia” has been carried
out by Dr. Sofiya Memon, in the Department of Anaesthesiology and Critical
Care, Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital, Raipur (C.G.) &
is a bonafide work done under my constant guidance and direct supervision to
my entire satisfaction.

Dated: Dr. K.K. Sahare (M.D.)

Raipur Professor & Head

Department of Anaesthesiology & Critical Care

Pt. J. N. M. Medical College & Dr. B. R. A. M. Hospital,

Raipur (C.G)
DEPARTMENT OF ANAESTHESIOLOGY AND CRITICAL CARE

Pt. J.N.M. MEDICAL COLLEGE & Dr. B.R.A.M. HOSPITAL

RAIPUR (C.G.)

Certificate
This to certify that the work entitled “Fentanyl as an adjuvant to
bupivacaine and ropivacaine in epidural labour analgesia” has been carried
out by Dr. Sofiya Memon, in the Department of Anaesthesiology and Critical
Care, Pt. J.N.M. Medical College& Dr. B.R.A.M. Hospital, Raipur (C.G.) & is
a bonafide work done under my constant guidance and direct supervision to
my entire satisfaction.

Dated: Dr. Jaya Lalwani (M.D., FICA)

Raipur (Guide)

Professor

Department of Anaesthesiology & Critical Care

Pt. J. N. M. Medical College & Dr. B. R. A. M. Hospital,

Raipur (C.G)
DEPARTMENT OF ANAESTHESIOLOGY AND CRITICAL CARE

Pt. J.N.M. MEDICAL COLLEGE & Dr. B.R.A.M. HOSPITAL

RAIPUR (C.G.)

Certificate
This to certify that the work entitled “Fentanyl as an adjuvant to
bupivacaine and ropivacaine in epidural labour analgesia” has been carried
out by Dr. Sofiya Memon, in the Department of Anaesthesiology and Critical
Care, Pt. J.N.M. Medical College& Dr. B.R.A.M. Hospital, Raipur (C.G.) & is
a bonafide work done under my constant guidance and direct supervision to
my entire satisfaction.

Dated: Dr. Tripti Nagaria (M.D., FICOG)

Raipur (Co-Guide)

Professor & HOD

Department of Obstetric and Gynaecology

Pt. J. N. M. Medical College & Dr. B. R. A. M. Hospital,

Raipur (C.G)
DEPARTMENT OF ANAESTHESIOLOGY AND CRITICAL CARE

Pt. J.N.M. MEDICAL COLLEGE & Dr. B.R.A.M. HOSPITAL

RAIPUR (C.G.)

Certificate
This to certify that the work entitled “Fentanyl as an adjuvant to
bupivacaine and ropivacaine in epidural labour analgesia” has been carried
out by Dr. Sofiya Memon, in the Department of Anaesthesiology and Critical
Care, Pt. J.N.M. Medical College& Dr. B.R.A.M. Hospital, Raipur (C.G.) & is
a bonafide work done under my constant guidance and direct supervision to
my entire satisfaction.

Dated: Dr. Chandrapal Bhagat (M.D.)

Raipur (Co-Guide)
Assistant Professor

Department of Anaesthesiology & Critical Care

Pt. J. N. M. Medical College & Dr. B. R. A. M. Hospital,

Raipur (C.G)
 DECLARATION

This thesis is a presentation of my original research work. Wherever, contributions of

others are involved every effort is made to indicate this clearly, with due reference to
the literature, and acknowledgement of collaborative research and discussions.

The work was done under the guidance of Prof. Dr. Jaya Lalwani mam, Professor,
Department of Anaesthesiology and Critical Care and co-guided by Dr. Tripti Nagaria
mam, Professsor & HOD, Department of Obstetric & gynaecology and Dr. Chandrapal
Bhagat, Assistant Professor, Departement of Anaesthesiology & Critical Care of Pt.
J.N.M Medical College & Dr. B. R. A. M. Hospital Raipur (C.G.)

Dr. Sofiya Memon

In my capacity as Guide of the candidate’s thesis, I certify that the above statements are
true to the best of my knowledge.

Dated: Dr. Jaya Lalwani (M.D., FICA )

Raipur (Guide)

Professor

Department of Anaesthesiology & Critical Care

Pt. J. N. M. Medical College & Dr. B. R. A. M. Hospital,

Raipur (C.G)
 ACKNOWLEDGEMENT
First & foremost, I want to offer this endeavor to almighty Allah for the wisdom bestowed
upon me, the strength, peace of my mind and good health in order finish this thesis.

To my extreme pleasure, I express gratitude towards my thesis guide, highly esteemed and
honourable teacher and mentor, Dr. Jaya Lalwani (M.D., FICA), Professor, for her unique
blend of expertise which kept me motivated during the tenure of this study. I am also highly
indebted for her guidance, constant supervision, motivation and positive criticism. During
these two and a half years, respected madam has always been approachable for discussions,
supportive towards resolving any issue which might have arisen during study. At times when
there were scarcity of required material necessary to perform the study, respected madam
went out of her way to arrange the same without reservations. No amount of words can
express my respect and faith towards madam.

I also take this opportunity to express my thank and gratitude to Dr. C.P. Bhagat (M.D.),
Assistant Professor. Sir has been the pillar of strength during the course of this study. His
patience, interest and mentoring led me to timely and fruitfully complete this study within the
due duration. His time to time advices and inputs for the betterment of the research work is
immeasurable.

Dr K.K. Sahare (M.D.), professor and HOD, a polite and relentless mentor, has been a
guiding light as and when required for the research work. His detailed oriented approach and
ability to give quick solutions was of immense help.

I also extend my heartfelt thanks and gratitude to Dr. P.J. Shah (M.D., FIPM), Professor &
former HOD. Her skilled inputs, experience, advices have been equal contributor to this
thesis work as her analytical and positive approach.

I must thank all the teachers, Associate Professors Dr. Rashmi Thakur, Dr. Rashmi Naik,
Dr. O.P. Sundrani, Dr Deepak Singh; Assistant Professors Dr. Manju Tandon, Dr.
Pratiksha Agrawal, Dr. Arunabh Mukherjee, Dr. Anisha Nagaria; Senior Residents Dr.
Siddharth and Dr Ashok who have been consistently present, appreciative and encouraging
of the ongoing work, thus pushing me to best of my capabilities to execute this work in the
best possible manner.
My sincere thanks to the Dean Madam, Joint Director cum Superintendent, Institutional
Ethics Committee & Scientific Committee, Pt. J.N.M. Medical College, Raipur (C.G.)
for permitting me to carry out this thesis work.

At all times good & bad, high & low one set of people who have always stood beside me and
gave me the love, affection & courage which kept me going incessantly, my family. Though
my feeling cannot be expressed in mere words, I would like to express thanks to my father
Mr. Zikar mohd. Memon and My mother Mrs. Shahnaz Baksh. Their constant support and
encouragement made me who I am today. My naniamma, Mrs. Sarah begum whose non-
stop prayers and blessings has done wonders and miracles for me. My elder sister Mrs.
Fouziya Memon whose motherly concerns, support at difficult times builds the very
foundation of my confidence and courage. My younger brother Nadeem who has shouldered
the responsibility when we sisters are away. I pray to Allah, that he always maintains his
inherent goodness and simplicity within him.

Faraz, my fiancée, is a towering support and always omnipresent during the course of this
journey.

My seniors Dr. Hemendra, Dr Nasir, Dr Ankit, Dr Rohit, Dr Mukesh, Dr Padamlochan,

Dr Prachi, Dr Ajay are the ones who have been a 24×7 support during the entire journey of
this study providing selfless guidance and being a polestar at the hour of need.

I would like to thank my dear friends Dr. Aparna mishra, Dr. Ayushee and Dr. Soumya for
their immense support, amicable company, positive energy and offering help at the hour of
need.

I deeply appreciate the help & co-operation of my colleagues & affectionate juniors. Among
them I would like to specially thank, Dr. Chandra Bhanu, Dr. Avinash, Dr Mukunda, Dr.
Rajesh, Dr Lesh, Dr. Lilly, Dr. Deepankar, Dr. Mukesh Nag, Dr. Vikas, Dr. Vinod, Dr.
Tarendra, Dr. Ummu, Dr. Dhananjay, Dr. Rupak, Dr. Sushma, Dr. Nikita, Dr. Ankita,
Dr.Bhairavi, Dr. Anil Gupta, Dr. Anil Dewangan, Dr. Trilok, Dr. Mrinalini, Dr.
Divyanand, Dr. Indresh and Dr. Rajendra.
Last but not the least, I would like to extend my thanks towards the staff of department of
Anaesthesiology & Critical Care, Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital,
Raipur (C.G.). I would also like to thank the patients who trusted me and kindly approved to
be the subject in this study. I also extend my gratitude to the authors of various studies whose
knowledge has been used in this study.

Date: Dr. Sofiya Memon

Raipur
 INDEX

S. NO. TITLE PAGE NO.

1 INTRODUCTION 1-3

2 REVIEW OF LITERATURE 4-17

ANATOMY OF LUMBAR SPINE &

3 18-28
PHYSIOLOGY OF LABOUR

4 PHARMACOLOGY 29-42

5 AIM & OBJECTIVES 43-44

MATERIAL AND
6 45-49
METHODOLOGY

7 OBSERVATION & RESULTS 50-72

8 DISCUSSION 73-92

9 SUMMARY AND CONCLUSION 93-96

10 BIBLIOGRAPHY 97-101

11 ABBREVIATIONS 102-104

12 CONSENT FORMS 105-109

13 PROFORMA 110-112

14 MASTER CHART