Comparison of Intravenous Paracetamol Versus Intravenous Tramadol for Labour Analgesia

Abstract

Background: Childbirth is an intensely painful physiological process, and while neuraxial analgesia remains the gold standard, systemic options like paracetamol and tramadol play a vital role in managing pain in resource-limited settings such Mirpur AJK.

Objectives: To compare the clinical analgesic efficacy of 1 g IV paracetamol versus 100 mg IV tramadol in women in active labour using mean change in VAS score.

Duration: 1 December 2025 to 4 March 2026.

Methodology: A randomized controlled trial with single-blinding was conducted at the Department of Obstetrics and Gynaecology, DHQ Teaching Hospital, Mirpur. Sixty term parturients (18-40 years old) were recruited through consecutive sampling during the active labour phase (≥ 4 cm dilatation) and randomized into two groups. Group P (30) was administered a 1g IV paracetamol infusion, and Group T (30) was administered a 100mg IV tramadol. The main outcome was measured by the mean change in VAS score 3 hours after the administration. The level of statistical significance was p ≤ 0.05.

Results: There were similarities in the demographic profiles of the groups at baseline (p > 0.05). The trial showed that Group P had better overall clinical outcomes, with a much shorter labour (4.7 ± 1.5 vs 6.3 ± 2.1 hours, p < 0.001) and greater maternal satisfaction (100% vs 80%, p = 0.024) than Group T. Although Group T was found to show a greater mean decrease in pain scores (4.71 ± 0.77) than Group P (3.21 ± 0.53) (p < 0.001, Mean Difference: 1.50, 95% CI: 1.17 to 1.83), it also had an increased incidence of opioid-related side effects and longer labour.

Conclusion: IV paracetamol is a safe and effective alternative to tramadol, offering adequate pain relief with fewer side effects and added benefits in labour outcomes.

Key Words: Active Labour, Intravenous Paracetamol, Intravenous Tramadol, Labour Analgesia