Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor

Abstract

The analgesic efficacy and maternal satisfaction is better with epidural analgesia than with opioids. Analgesia provided by meperidine and tramadol is comparable and approximately 50% of women rated the analgesia as good. Meperidine is better in the second stage than tramadol. Hence in developing nations where availability of facilities is the main limiting factor, intramuscular opioids can be considered suitable alternatives.

Intravenous patient-controlled analgesia with remifentanil in early labour

“…It was suggested that the type of rescue medicine would have an effect on the pain level at which a top-up is requested as the patient considers not only the pain that can be tolerated but also the possible side effects that will come with the rescue medicine. This suggestion is supported by the fact that in labour pain, Jain et al (2003) noted that significantly more (67%) women request a top-up when the pain score was less than 7 during EDA compared with opioid analgesia (30% and 31.8% with pethidine and tramadol, respectively) which is probably associated with an increased risk of side effects as compared to EDA. Another possible explanation for this difference observed by Jain et al (2003) is that women using an opioid analgesia find it easier to stand a stronger pain than those with EDA.…”

“…The superiority of EDA in comparison with systemic opioid analgesia is well established in a number of RCTs (table 2). There seems to be a steep fall in pain scores (0-10) from 7.1-7.9 to 0-4 during the first hour (Thorp et al 1993, Bofill et al 1997, Jain et al 2003) with a sustained effect throughout the 1 st stage of labour. Most studies compared EDA with systemic pethidine which has been thought to provide near to no analgesia at all in labour pain (Olofsson et al 1996b, Ranta et al 1994.…”

“…Maternal satisfaction with labour analgesia has been assessed with direct questioning using a VAS or VRS for satisfaction or by asking the parturients to give a pain relief score after the delivery. Abboud et al (1981), Philipsen & Jensen (1990), Sharma et al (1997) and Jain et al (2003) used the question of whether the patient would have the same agent again as an indirect proxy to patient satisfaction.…”

“…Most studies compared EDA with systemic pethidine which has been thought to provide near to no analgesia at all in labour pain (Olofsson et al 1996b, Ranta et al 1994. A decrease of pain by 0-4 with systemic opioid analgesia from a baseline pain score of 6.9-9 on a scale of 0-10 has been noted, however, in several large studies (Thorp et al 1993, Ramin et al 1995, Sharma et al 1997, Bofill et al 1997, Jain et al 2003 (table 2). In a systematic review, Leighton & Halpern (2002) calculated a weighted mean difference of 40 mm in favour of EDA for the 1 st stage of labour (p < 0.0001).…”

“…With respect to patient satisfaction with the analgesia, EDA has consistently ranked better than systemic opioid analgesia (Leighton & Halpern 2002). Jain et al (2003) pointed out, however, that while mothers using systemic opioid analgesia did not consider the pain relief excellent as often as those using EDA, a considerable proportion rated it as very good or good. In RCTs comparing epidural with opioid analgesia, a larger proportion (73-95%) of mothers in the epidural groups stated that they Table 1 would opt for a similar analgesia in any future labour compared with 30-70% of the women in the opioid groups (table 2).…”