Lack of Analgesic Effect of Systemically Administered Morphine or Pethidine on Labour Pain

Olofsson, Christina; Ekblom, A.; Ekman-Ordeberg, Gunvor; Hjelm, A.; Irestedt, L.

doi:10.1097/00006254-199707000-00006

Cited by 40 publications

(57 citation statements)

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“…The rate of use of parental opioids was between 39% and 56% in various hospital obstetrics units in the United States (10). However, many studies have suggested that intramuscular pethidine may be ineffective at relieving labor pain and that their use may even be unethical and medically incorrect (18, 19).…”

Section: Discussionmentioning

confidence: 99%

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A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

et al. 2016

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BackgroundThe use of pain-relieving drugs during labor is now part of standard care in many countries throughout the world. Each method of pain relief has its own risks and benefits, variations in effectiveness, and availability and acceptability.ObjectivesThis study aimed to assess the efficacy and safety of intramuscular pethidine as an analgesic during labor by comparing it to inhaled 50% nitrous oxide (Entonox).MethodsIn this clinical trial study, 100 women who expected to have a natural childbirth were observed. The inclusion criteria for this study were the commencement of spontaneous labor pain along with appropriate maternal and fetal indications for vaginal delivery. By using random numbers, each subject was randomly allocated to one of two groups, with one group using Entonox and the other receiving an intramuscular injection of 0.5 mg/kg of pethidine for pain relief. The intensity of labor pain experienced by the subjects and the outcomes of the deliveries were collected with questionnaires.ResultsThe average pain scores in the Entonox and pethidine groups were 3.94 ± 1.4 and 5.6 ± 1.1, respectively, 30 minutes after intervention (P = 0.001), but there was not a significant difference in the severity of the pain (5.06 ± 1.4 and 4.7 ± 1.1 for the Entonox and pethidine groups, respectively) between the subjects in each group 60 minutes after the intervention (P = 0.592). No significant differences were seen in the duration and interval of uterine contractions, maternal complications, Apgar scores, and the duration of the first and second stage of labor between the two studied groups (P > 0.05). An analysis of the pooled risk differences showed that none of the side effects investigated were significantly different between the two groups except for mouth dryness, which was significantly higher in nitrous oxide users (P = 0.044).ConclusionsInhaled nitrous oxide seems to give better pain relief in the short term compared to a single dose of pethidine. Entonox, which is more convenient to administer than an intramuscular injection of pethidine, is also regarded as safe both for mothers and neonates.

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Section: Discussionmentioning

confidence: 99%

“…Systemic pethidine is routinely used throughout the UK for labor analgesia (10, 11). However, systemic opioids lead to some complications for mothers (12, 13) and babies (14).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

et al. 2016

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“…There are a number of concerns in the literature regarding the use of pethidine. Some studies have suggested that pethidine provides little or no pain relief in labour, its main effect being to cause sedation rather than analgesia 1819. Pethidine also has a number of side effects on both mother and neonate which make it a less ideal choice for labour analgesia.…”

Section: Discussionmentioning

confidence: 99%

Intravenous paracetamol versus intramuscular pethidine in relief of labour pain in primigravid women

et al. 2014

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Background:Intramuscular pethidine is one of most common opioids used for labour analgesia. There are a number of concerns in the literature regarding the use of pethidine. The aim of this study is to compare analgesic efficacy of paracetamol with pethidine for labour pain in normal vaginal delivery.Materials and Methods:In this single-blinded, randomised control trial, 80 primigravid singleton women with full-term pregnancy candidate for normal vaginal delivery, were entered the trial and divided in to pethidine (A) and paracetamol (B) groups. At the time of admission, age and body mass index of mother and gestational age based on last day of period were recorded. In both groups, intravenous promethazine and hyoscine were administered to each patient at the first stage of delivery. From beginning of active phase of delivery, patients in group A received 50 mg intramuscular pethidine injection. At the same time patients in group B, received an intravenous solution infusion containing 1000 mg paracetamol and 300 cc of normal saline. After child birth, average labour pain was assessed using Visual Analogue Scale (VAS) by direct questioning from patient in both groups.Results:After patients' selection, 19 individual omitted during study due to exclusion criteria and finally 30 patients in paracetamol group and 31 patients in pethidine group remained to enter the trial. There was no significant difference in age and BMI of mothers between both groups (P > 0.05). Maternal age and labour duration in paracetamol group had no meaningful difference with maternal age and labour duration of patients in pethidine group (P > 0.05). The average VAS pain score was significantly lower in paracetamol comparing to that of pethidine group (8.366 out of 10, 9.612 out of 10, respectively, P < 0.001).Conclusion:It is concluded that intravenous paracetamol is more effective than intramuscular pethidine to relief labour pain in normal vaginal delivery.

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“…There is a high incidence of maternal side effects, and at best, analgesia is incomplete. Existing data suggest that opioids provide little significant analgesia 44–46. Although meperidine is the most commonly used systemic opioid, there are few studies comparing opioids and little scientific evidence that one opioid is better than another.…”

Section: Systemic Analgesiamentioning

confidence: 99%

Advances in labor analgesia

Wong¹

2009

IJWH

131

142

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The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum. An array of regional nerve blocks, systemic analgesic, and nonpharmacologic techniques are currently used for labor analgesia. Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study. Continuous labor support has been shown to decrease the use of pharmacologic analgesia and shorten labor. Intradermal water injections decrease back labor pain. Neuraxial labor analgesia (most commonly epidural or combined spinal-epidural) is the most effective method of pain relief during childbirth, and the only method that provides complete analgesia without maternal or fetal sedation. Current techniques commonly combine a low dose of local anesthetic (bupivacaine or ropivacaine) with a lipid soluble opioid (fentanyl or sufentanil). Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.

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Lack of Analgesic Effect of Systemically Administered Morphine or Pethidine on Labour Pain

Cited by 40 publications

References 0 publications

A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

Intravenous paracetamol versus intramuscular pethidine in relief of labour pain in primigravid women

Advances in labor analgesia

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