Comparison of analgesic efficacy of paracetamol and tramadol for pain relief in active labor

J Clin Anesth. 2015 Mar;27(2):159-63. doi: 10.1016/j.jclinane.2014.08.008. Epub 2014 Nov 28.


Study objective: To evaluate the efficacy and safety profile of paracetamol in comparison with tramadol for pain relief during active labor.

Design: Prospective, randomized, double-blind study.

Setting: Maternity Wing of the Postgraduate Institute of Medical Education and Research, Chandigarh.

Patient: Sixty laboring, primiparous, full-term parturients with uncomplicated, singleton pregnancy in spontaneous labor and cervical dilatation of 3-5 cm.

Intervention: Parturients were randomized into 2 groups to receive either 1 mg/kg of tramadol intramuscularly (group T; n = 29) or 1 g of paracetamol intravenously (group P; n = 30). Same doses of the drugs were repeated after 4 hours of initial dose.

Measurement: Primary outcome of the study was to assess the analgesic efficacy of the 2 drugs as measured by visual analog scale (VAS) score. Secondary outcome recorded was duration of labor, presence of any maternal, or fetal adverse events during the study.

Results: Both the groups showed comparable VAS scores at all times of observation. Lower mean VAS scores were reported in both the groups till 120 minutes only. The duration of first stage of labor was shorter in group P (248.00 ± 98.171 vs 340.63 ± 111.592 minutes; P = .003). The duration of second stage of labor was comparable between the 2 groups. Higher incidence of maternal side effects such as nausea/vomiting and sedation was associated with the use of tramadol. Neonatal outcome was comparable.

Conclusion: Intravenous paracetamol provides comparable analgesia as intramuscular tramadol during active labor.

Keywords: Active labor; Analgesia; Paracetamol; Side effects; Tramadol.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / administration & dosage*
  • Acetaminophen / adverse effects
  • Adult
  • Analgesia, Obstetrical / adverse effects
  • Analgesia, Obstetrical / methods*
  • Analgesics, Non-Narcotic / administration & dosage*
  • Analgesics, Non-Narcotic / adverse effects
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Humans
  • Infusions, Intravenous
  • Injections, Intramuscular
  • Labor, Obstetric*
  • Pain / prevention & control
  • Pain Measurement / methods
  • Pregnancy
  • Prospective Studies
  • Tramadol / administration & dosage*
  • Tramadol / adverse effects
  • Young Adult


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Acetaminophen
  • Tramadol