A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate

Mędrzycka‐Dąbrowska, Wioletta; Czyż-Szypenbejl, Katarzyna; Pietrzak, Jakub

doi:10.5603/gp.a2018.0079

Cited by 6 publications

(9 citation statements)

References 28 publications

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“…However, opioids by parenteral administration are not as effective as EA and are not seen as an option when EA is available [157]. Although other drugs have been used, the EA remains the most efficient for releasing labour pain [4]. However, it should be highlighted that this method of analgesia is expensive and not available in many institutions [146].…”

Section: Managing Labour Painmentioning

confidence: 99%

“…However, it should be highlighted that this method of analgesia is expensive and not available in many institutions [146]. In recent years, a growing interest has emerged in the combined spinal-epidural method (CSE) for labour analgesia, with the benefit of utilising lower doses of local anaesthetics and rapid analgesia [4,150,161,168]. Advancement in knowledge and developing a novel therapy for labour pain has been partially limited by the absence of an animal model for this kind of pain.…”

Section: Managing Labour Painmentioning

confidence: 99%

“…Parturition is a significant event for numerous species and is frequently the most painful experience that females suffer [3]. Unlike other acute pain experiences, labour pain is physiological and unique, not associated with disease or trauma, and its presence does not indicate any pathology, but the progression of labour itself [4], and the most basic experience of life, the birthing of a new individual [5]. However, several factors may hinder the normal process of parturition and modify or increase the degree of pain caused by it.…”

Section: Introductionmentioning

confidence: 99%

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Parturition in Mammals: Animal Models, Pain and Distress

Martı́nez-Burnes

Muns

Barrios-García

et al. 2021

Animals

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Parturition is a complex physiological process and involves many hormonal, morphological, physiological, and behavioural changes. Labour is a crucial moment for numerous species and is usually the most painful experience in females. Contrary to the extensive research in humans, there are limited pain studies associated with the birth process in domestic animals. Nonetheless, awareness of parturition has increased among the public, owners, and the scientific community during recent years. Dystocia is a significant factor that increases the level of parturition pain. It is considered less common in polytocous species because newborns’ number and small size might lead to the belief that the parturition process is less painful than in monotocous animal species and humans. This review aims to provide elements of the current knowledge about human labour pain (monotocous species), the relevant contribution of the rat model to human labour pain, and the current clinical and experimental knowledge of parturition pain mechanisms in domestic animals that support the fact that domestic polytocous species also experience pain. Moreover, both for women and domestic animal species, parturition’s pain represents a potential welfare concern, and information on pain indicators and the appropriate analgesic therapy are discussed.

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Section: Managing Labour Painmentioning

confidence: 99%

Section: Managing Labour Painmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Parturition in Mammals: Animal Models, Pain and Distress

Martı́nez-Burnes

Muns

Barrios-García

et al. 2021

Animals

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“…The results of studies demonstrate that more than 23% of primiparas characterize this pain as unbearable, 65% as very strong or strong, and only 9% as bearable. On the other hand, only 17% of multiparas describe this pain as unbearable, 46% as very strong or strong, and 25% as acceptable [3,4]. The factors which have an impact on labor pain are physiological, psychological, and social.…”

Section: Introductionmentioning

confidence: 99%

“…Non-pharmacological pain management includes a broad spectrum of techniques, including water immersion (shower, bathtub) or transcutaneous electrostimulation. They aim to alleviate the physical perception of pain and prevent suffering by improving psychological and mental elements of care [4]. Pain management has a low priority in many countries with low and medium incomes [8].…”

Section: Introductionmentioning

confidence: 99%

A Cross-Sectional Survey of Labor Pain Control and Women’s Satisfaction

Pietrzak

Mędrzycka‐Dąbrowska

Tomaszek

et al. 2022

IJERPH

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Introduction: Pain experienced during labor is a symptom of contractile activity and is a physiological feature of the uterus that occurs at the appropriate stages of labor. For the majority of women, labor pain is the most severe pain they will ever experience, and therefore should be relieved. Objective: (1) To evaluate labor pain intensity before and after using non-pharmacological and pharmacological interventions; (2) to assess women’s satisfaction of labor pain management. Methods: A multicenter cross-sectional survey study was performed on 500 women who gave birth in different reference level hospitals (i.e., I, II, III). Pain intensity was assessed according the Numeric Rating Scale (range 0–10), whereas women’s satisfaction was measured with a 5 point Likert scale. Results: The use of both non-pharmacological (median 6.7 (5; 8) vs. 4.5 (3.3; 5.5)) and pharmacological methods (median 8 (7; 9) vs. 5 (3; 6)) resulted in a significant reduction in pain (p < 0.01). Water immersion and epidural anesthesia proved to be the most effective non-pharmacological and pharmacological methods, respectively. In hospitals of reference I, analgesic management was based primarily on the use of non-pharmacological techniques, less often mixed, i.e., non-pharmacological and pharmacological techniques (27.5%). On the other hand, in hospitals with higher referentiality, mixed methods were used more often (level II—65.8%; level III—81.2%). Pain intensity was significantly higher (p < 0.0001) in hospitals with reference level I (median 5 (4; 6)) than in the hospitals with reference level II (median 4.2 (3; 5)) or level III (median 4.2 (3.3; 5.4)). Epidural anesthesia was most often performed (60%) in the hospital of reference II. Women’s satisfaction (median 4 (3; 5)), inter alia, was associated with the effectiveness of applied methods. Conclusions: The study findings suggest that women giving birth in hospitals of higher referentiality have better control of labor pain due to access to pharmacological methods. Epidural anesthesia remains the gold standard for relieving labor pain. The choice of a specific method is determined by the degree of hospital and associated with the pain referentiality.

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