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Go Back       Himalayan Journal of Medicine and Surgery | Volume:3 Issue:4 | July 30, 2022
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DOI : 10.47310/Hjms.2022.v03i04.014       Download PDF       HTML       XML

Evaluation of the Effect of Vedic Chants on Sensory Blockade Level, Number of Epidural Activations and Dose of Drug Required for Labor Analgesia in Laboring Parturients with Ambulatory Epidural Labor Analgesia


Dr. Shelly1, Dr. Nitin Patiyal2, Dr. Chander Mohan Negi*3 and Dr. Poonam4

1Dr. Shelly, Department of Anaesthesiology, Civil Hospital, Karsog, Mandi, (H. P.), India

2Dr. Nitin Patiyal, Department of Pharmacology, Dr. Rajendra Prasad Govt. Medical College, Kangra At Tanda, (H. P.), India

*3Dr. Chander Mohan Negi, Department of Anaesthesiology, Regional hospital, Reckong Peo, Kinnaur, (H. P.), India

4Dr. Poonam, Department of Anaesthesiology, Civil Hospital, Tauni Devi, Hamirpur, (H. P.), India


*Corresponding Author

Dr.Chander Mohan Negi


Article History

Received: 10.07.2022

Accepted: 20.07.2022

Published: 30.07.2022


Abstract: Background: The present study was undertaken to evaluate the effect of Vedic chants on Sensory blockade level, number of epidural activations and dose of drug required for labor analgesia in Laboring Parturients with Ambulatory Epidural Labor Analgesia. Material & Methods: A total of 38 patients with full term live cephalic singleton pregnancy in active labor with cervical dilatation 0-4 cm with a request for ambulatory labor analgesia admitted in department of Obstetrics and Gynaecology at Dr. RPGMC Kangra at Tanda were participated in this study. We randomized the patients in two groups A and B. Both groups received epidural labor analgesia with 0.1% ropivacaine and 1.5ug/ml of fentanyl. Patients in group A were made to listen Vedic chants (Gayatri mantra) in 4 sessions of 30 min each with 15mins break in between the sessions. In group B, patients received only ambulatory epidural labor analgesia without any Vedic chants listening. These two groups were observed for the various parameters till the delivery of the baby. Results: The two groups were comparable in terms of age, height, weight, BMI, occupation, parity, POG, mean cervical dilatation and contractions per 5minutes at the time of administration of labor analgesia and were statistically non-significant (p >0.05). Mean number of epidural activations of the patients in group A was comparable to that in group B (11.9±1.8 vs. 11.4±2.3; p = 0.544). Mean dose (in ml) of ropivacaine and fentanyl of the patients in group A was comparable to that in group B (35.6±5.5 vs. 34.4±6.8; p = 0.544). In Group A, 4 (25%), 9 (56%), 1 (6%) and 2 (13%) had sensory blockade level at T4, T6, T8 and T10 respectively. In Group B, 4 (18%), 12 (55%), 4 (18%) and 2 (9%) had sensory blockade level at T4, T6, T8 and T10 respectively. Conclusion: In our study, Mean number of epidural activations of the patients, Mean dose of ropivacaine and fentanyl and sensory blockade level were comparable in both groups.


Keywords: Evaluation, Vedicchants, Sensory blockade level, epidural activations and dose of labor analgesia, Laboring Parturients, Ambulatory Epidural Labor Analgesia .


INTRODUCTION

Primary advantage of ambulation in labor includes parturient freedom of mobility, autonomy and self-control in labor, increased uterine activity and intensity of contractions, decreased frequency of contractions, decreased pain and duration of the first stage of labor, fewer incidences of fetal heart rate abnormalities and decreased incidence of operative and/or assisted deliveries.1


Music therapy is one of the non-pharmacological methods for pain relief in several disorders. One of the psychological effects of music therapy is relaxation, which can decrease heart rate, respiratory rate and metabolism. Familiar music to patients distract them from anxious state and counterbalancing negative emotions and triggers good and pleasant memories.2,3


Recently, the role of cultural chants in reducing pain in labor has been reported. Chantsing and deep breathing experiences as music therapy during the latent stage of labor may reduce pain perception and pain behaviors.4


Listening to Vedic chants and Indian classical instrumental music has beneficial effects on alleviating anxiety levels induced by apprehension of invasive procedures and can be of therapeutic use.5


There is insufficient evidence to make a judgment about whether or not Vedic chants have any effect on Sensory blockade level, epidural activations and dose of labor analgesia. In the present study, we aimed to evaluate the effect of Vedic chants on Sensory blockade level, number of epidural activations and dose of drug required for labor analgesia in Laboring Parturients with Ambulatory Epidural Labor Analgesia.


AIM & OBJECTIVES:

To evaluate the effect of Vedic chants on Sensory blockade level, number of epidural activations and dose of drug required for labor analgesia in Laboring Parturients with Ambulatory Epidural Labor Analgesia.


MATERIALS & METHODS:

  • Study Site:

Departments of Anaesthesia, and Obstetrics & Gynaecology, Dr RPGMC Kangra at Tanda (rural), Himachal Pradesh.


  • Study Design: Prospective randomized controlled study.


  • Study Duration:

The study was conducted over the period of 18 months including data collection, data organization, presentation, analysis, and interpretation.


  • Sample Size:

Sample size was calculated to a total of 80 patients (40 patients in each group). But due to COVID-19 pandemic limitations, only 38 patients (16 in Group A and 22 in Group B) were included in the study.


  • Inclusion Criteria:

Term live cephalic singleton pregnancy in active labor who were having contractions at least once in 5 min with cervical dilation 0–4 cm with a request for ambulatory labor analgesia were included in the study.


  • Exclusion Criteria:

  • Patient refusal for the procedure.

  • Local infection at site of epidural catheter placement.

  • Thrombocytopenia.

  • Coagulopathies.

  • HELLP syndrome.

  • Sepsis.

  • Deafness.

  • Spinal column deformities and spine surgery.

  • Patient having hypersensitivity to the study drug.

  • In case of Intrathecal catheter placement.

  • In case of accidental dural puncture.

  • Non-assuring fetal heart rate.

  • Prematurity and post-maturity.


  • Methodology:

After the intimation from obstetrician, the information regarding the epidural labor analgesia was explained to the laboring parturient and thereafter written consent for epidural labor analgesia was taken by the anaesthetist on duty. Before commencing the procedure, a case record form was filled for each patient. After that patient was taken to labor analgesia room in maternity complex. Patients were coloaded with 10 ml/kg of ringer lactate over 15 minutes, after securing intravenous line and all standard monitors like BP, SPO2, ECG attached, and vitals were recorded in case record sheet. Patient was positioned in the left lateral or sitting position and the procedure was carried out under all aseptic precaution. Skin was infiltrated with 2ml of 2% xylocaine at L2-3 or L3-4 intervertebral space. Epidural space was identified using a loss of resistance technique to normal saline with an 18G Tuohy’s needle and 20-gauge multi-orifice catheter was threaded through the cephalad directed tip of the epidural needle to a depth of 5 cm into the epidural space. The catheter was secured and the patient was placed in the supine position.


  • Drug Preparation for Epidural Activation:

Epidural drug was prepared by taking two, 10ml of syringes. In each syringe 5ml of 0.2% ropivacaine with 3.5ml of 0.9% normal saline and 1.5ml of fentanyl (10µg/ml) was added to it. Thus, a total of 20ml of drug was prepared with a final concentration of 0.1% ropivacaine and 1.5ug/ml of fentanyl in it for loading the epidural space.


  • Activation of Epidural Catheter for Labor Analgesia:

The prepared drug was given in increments of 3ml and each increment was considered as the test dose given after negative aspiration for blood and CSF and time was noted every time the increment given. The adequacy of analgesia was assessed 5min after the increment of drug administered. Analgesia was considered adequate if pain score was <3.


Onset of analgesia was defined as from time of test dose to time of achieving VAS <3. If analgesia would not be adequate within 10mins after the increment given, then another increment of 3ml was given in order to achieve the VAS <3.


Sensory block height was assessed by loss of sensation to pin prick (blunt head of a pin). Onset of analgesia was defined as duration from injection of first test dose to attainment of VAS <3.


Presence of motor block in lower extremities was assessed using a modified Bromage scale (MBS).


Patient was instructed to pass the urine as and when required by her, accompanied by attendants.


  • Vedic Chanting Procedure:

Randomization was done by computer generated random sequence number method to randomly divide them in two groups A and B. In group A, 16 and in group B, 22 patients were taken due to covid-19 pandemic limitations.

  • Group A:

All the patients listened to an already downloaded Vedic chants (Gayatri mantra) in mobile phone [Moto G2 (which belong to primary investigator) by earphones or by playing it in the background depending upon the patient’s choice] in 4 sessions of 30 minutes each with 15 minutes break in between after established epidural labor analgesia and consent of the patients.


  • Group B:

All the patients got only epidural labor analgesia and did not listen to Vedic chants (Gayatri mantra).


Labor was managed according to Obstetric department’s standard protocol. The epidural catheter was removed after normal or cesarean delivery.


  • Ethical Consideration:

The study was initiated following approval from Institutional Ethics Committee (IEC) at Dr. RPGMC Kangra at Tanda. Consent form was collected from each enrolled study subject.


STATISTICAL ANALYSIS:

The data was entered in Microsoft excel spreadsheet. Statistical analysis was done using Microsoft excel and exported into SPSSv21.0 and online ‘social science statistics’ software. The quantitative data was analyzed and expressed as mean±SD and percentages. Student’s t-test was used for comparing continuous variables between the two groups. Chi square and Fisher’s exact test was used for comparing the categorical data between the two groups.


OBSERVATIONS & RESULTS:

The present study compared the effect of ambulatory epidural labor analgesia with Vedicchants (EA+VC) and ambulatory epidural labor analgesia (EA) alone on Sensory blockade level, epidural activations and dose of labor analgesia. A total of 38 patients were included in the study at Department of Anaesthesiology and Department of Obstetrics & Gynaecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda. Results of the study have been presented below:


Image is available at PDF file


  • Treatment Arms:

Patients were randomly divided into two groups. The patients in group A were made to listen to Vedicchants (Gayatri mantra) after established epidural labor analgesia and patients in group B received only epidural labor analgesia.


Table 1: Treatment arms

Group

Description

Frequency

A

Epidural labor analgesia + Vedicchants

16

B

Epidural labor analgesia

22


Mean age of the patients in group A (25.1±4.8) was comparable to that in group B (25.6±3.3); p = 0.69. Mean height of the patients in group A was comparable to that in group B (156.9±3.5 vs. 157±3.2; p = 0.955). Mean weight of the patients in group A was comparable to that in group B (61.4±7.9vs. 62.6±6.5; p = 0.623). Mean BMI of the patients in group A was comparable to that in group B (22.5±4.4 vs. 21.1±4.2; p = 0.170). Mean POG of the patients in group A was comparable to that in group B (39.1±0.8 vs. 39.1±0.9; p = 0.914).


Table 2: Comparison of socio-clinical variables between two groups


Group A (n=16)

Group B (n=22)

P - value*

Age(years)

25.1±4.8

25.6±3.3

0.69

Height (In cm)

156.9±3.5

157±3.2

0.955

Weight (In Kg)

61.4±7.9

62.6±6.5

0.623

BMI

24.9±2.8

25.4±2.6

0.595

POG

39.1±0.8

39.1±0.9

0.914

Mean number of epidural activations of the patients in group A was comparable to that in group B (11.9±1.8 vs. 11.4±2.3; p = 0.544).


Table 3: Comparison of mean number of epidural activations between two groups


Group A (n=16)

Group B (n=22)

P - value*

Number of epidural activations

11.9±1.8

11.4±2.3

0.544

Mean dose (in ml) of ropivacaine and fentanyl of the patients in group A was comparable to that in group B (35.6±5.5 vs. 34.4±6.8; p = 0.544).


Table 4: Comparison of mean dose of Ropivacaine and Fentanyl between two groups


Group A (n=16)

Group B (n=22)

P - value*

Dose of Ropivacaine and Fentanyl

35.6±5.5

34.4±6.8

0.544


In Group A, 4 (25%), 9 (56%), 1 (6%) and 2 (13%) had sensory blockade level at T4, T6, T8 and T10 respectively. In Group B, 4 (18%), 12 (55%), 4 (18%) and 2 (9%) had sensory blockade level at T4, T6, T8 and T10 respectively.


DISCUSSION:

In present study mean number of epidural activations of the patients in group A was 11.9±1.8and in group B it was 11.4±2.3. The difference between two was non-significant (P = 0.544). Similarly mean dose (in ml) of ropivacaine and fentanyl of the patients in group A was 35.6±5.5 and in group B it was 34.4±6.8. The difference of two was non-significant (P = 0.544). So we concluded that there was no difference in the dose requirement and number of epidural activations in either of the group to achieve adequate ambulatory labor analgesia. So we could say that the efficacy of the drug in providing labor analgesia was adequate.


In present study, in Group A a total of 9 patients had sensory block level up to T6, 4patient up to T4, 2 patients up to T10 and 1 patient had sensory block up to level T8.In group B a total of 12 patients had sensory block up to T6, 4 patients up to T4, 4 patients up to T8 and 2 patients had sensory blockade level up to T10.The difference in sensory blockade level in patients between these groups was non-significant P >0.05). We concluded that in our study both groups attained sensory blockage level between T4 – T10 and none of the patients in our study had incidence of higher sensory blockade in either of the groups with the drug used in our study.


CONCLUSION:

In our study, we concluded that there was no difference in the dose requirement and number of epidural activations in either of the group to achieve adequate ambulatory labor analgesia. In our study both groups attained sensory blockage level between T4 – T10 and none of the patients in our study had incidence of higher sensory blockade in either of the groups with the drug used in our study.


REFERENCES:

  1. Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. The Lancet. 2001 Jul 7;358(9275):19-23.

  2. Phumdoung S, Good M. Music reduces sensation and distress of labor pain. Pain management nursing. 2003 Jun 1;4(2):54-61.

  3. Mok E, Wong KY. Effects of music on patient anxiety. AORN journal. 2003 Feb 1;77(2):396-410.

  4. Ramesh B, Sundar S, Jayapreetha R, Samal S, Ghose S. Effects of culture-based chants on labor pain during the latent stage of labor in primigravidae mothers: a randomized controlled trial. J Basic Clin Appl Health Sci. 2018;2(1):16-9.

  5. Padam A, Sharma N, Sastri OS, Mahajan S, Sharma R, Sharma D. Effect of listening to Vedic chants and Indian classical instrumental music on patients undergoing upper gastrointestinal endoscopy: A randomized control trial. Indian Journal of Psychiatry. 2017 Apr;59(2):214.

  6. Cohen J. After office hours. Obstetrics & Gynecology. 1996 Nov 1;88(5):895-8.

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