Comparison Between Neostigmine and Fentanyl as Adjuvant to Bupivacaine in Epidural Labour Analgesia: A Randomized Control Trial

Background: Epidural analgesia is considered the gold standard for labour pain management. Opioid adjuvants such as fentanyl are commonly combined with bupivacaine to enhance analgesic efficacy and reduce local anesthetic requirement; however, opioid-related side effects remain a concern. Neostigmine, a cholinesterase inhibitor, has emerged as a potential non-opioid alternative for neuraxial analgesia. Objective: To compare the analgesic efficacy and safety of neostigmine versus fentanyl as adjuvants to bupivacaine in epidural labour analgesia. Methods: In this prospective randomized single-blinded controlled trial, 60 ASA I–II parturients in active labour were randomly allocated into two groups (n=30 each). Group N received epidural bupivacaine (1.25 mg/mL) with neostigmine 2 µg/mL, while Group F received bupivacaine with fentanyl 2 µg/mL. Primary outcomes included duration of analgesia and total bupivacaine consumption. Secondary outcomes included time to full cervical dilatation, rescue bolus requirement, maternal side effects, and neonatal outcomes. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p