Clinical outcomes and maternal satisfaction with opioids and bupivacaine spinal labor analgesia

Background: Epidural analgesia is the preferred method for labor pain relief in high-income countries; however, its use is often restricted in low-resource settings due to cost, equipment needs, and the requirement for skilled personnel. Spinal labor analgesia (LA) offers a simpler and more affordable alternative suitable for low- and middle-income countries. This study evaluated clinical outcomes and maternal satisfaction with spinal LA (SLA) using bupivacaine and opioids compared with no analgesia during labor. Materials and Methods: A prospective, quasi-experimental study was conducted among 126 parturients at ≥37 weeks’ gestation in the active phase of labor. Participants were allocated into two groups: intrathecal (LA, n = 63; bupivacaine 2 mg, morphine 0.2 mg, fentanyl 25 µg) and no LA (NLA, n = 63). Clinical outcomes assessed included analgesic efficacy, haemodynamic stability, labor progress, neonatal wellbeing, and maternal satisfaction. Results: Baseline pain with visual analogue scale scores were comparable ( P = 0.195). Within five minutes, the LA group achieved near-complete pain relief (0.05 ± 0.21 vs. 9.52 ± 1.17; P = 0.001). Total labor duration was significantly shorter in the LA group (4.08 ± 2.56 vs. 8.59 ± 4.48 h; P = 0.001), marked reductions in both first and second stages, and uterine contractions were more frequent and sustained in the LA group. Neonatal outcomes were superior, with higher APGAR scores at 1 and 5 min ( P < 0.05). Maternal satisfaction was also greater, with no major adverse effects observed. Conclusion: SLA using bupivacaine and opioids provides rapid and effective pain relief, supports favorable maternal and neonatal outcomes, and demonstrates an excellent safety profile. Its simplicity, low cost, and minimal resource requirements make it a practical and feasible option for LA in low-resource settings.