Comparative Analysis of Intravenous Paracetamol and Tramadol for Labor Analgesia: Efficacy and Safety

Objective: This study aims to compare the efficacy and safety of intravenous paracetamol and intramuscular tramadol for labor analgesia. Study Design and Setting: This study was conducted for 1 year at PNS Shifa Hospital, Karachi (Sept 01, 2023 – Aug 31, 2024). Convenient sampling into two groups was done (Group A: IV Paracetamol n=50; and Group B: IM Tramadol n=50) of 100 laboring women. Visual Analogue Scale was used to assess pain intensity at baseline, 1 and 3 hours post administration. Methodology: During the active phase of labor, participants were given either 1,000 mg IV paracetamol or 100 mg IM tramadol. Labor progression was monitored and the levels of pain were recorded on the VAS. Statistical tests were used to analyze maternal side effects and neonatal outcomes such as NICU admissions with a significance threshold of p<0.05. Results: Superior pain relief was given by paracetamol with significantly lower VAS scores at 1 hour (4.44 vs. 5.55, p=0.0) and 3 hours (6.51 vs. 6.96, p= 0.0). In the paracetamol group, labor duration of paracetamol group was shorter in the first stage (10.16 vs. 11.44 hours, p=0). The number of frequent maternal side effects was higher in the tramadol group (24 vs 12%, p=0.118). Furthermore, there was no difference in NICU admissions or emergency cesarean rates (p=0.315). Conclusion: Intravenous paracetamol is a safer and better alternative for labor analgesia as compared to intramuscular tramadol, having better pain control, shorter duration of labor and less maternal side effects and similar neonatal outcomes.