Beyond the epidural: Alternatives to neuraxial labor analgesia

Sharpe, Emily E.; Rollins, Mark D.

doi:10.1016/j.bpa.2022.04.005

Cited by 10 publications

(7 citation statements)

References 61 publications

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“…Furthermore, drug labour pain relievers include inhaled nitrous oxide (N2O) as an old-age analgesia pain relief during labour [ 6 ], meperidine [ 2 ], nalbuphine [ 7 ], and morphine [ 8 ]. Tramadol [ 9 , 10 ], fentanyl [ 8 ], and remifentanil patient-controlled analgesia [ 11 ] are also utilised as labour pain relievers. Acetaminophen has been shown to be the safest, requiring minimal monitoring [ 12 , 13 ], providing modest pain relief [ 14 ], and having fewer maternal side effects [ 11 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Notwithstanding the advantage of opioids in producing analgesia with mild effect on sensation and proprioception [2], their negative side-effects during labour include nausea, vomiting, pruritus, sedation, and respiratory depression [3][4][5]. Furthermore, drug labour pain relievers include inhaled nitrous oxide (N2O) as an old-age analgesia pain relief during labour [6], meperidine [2], nalbuphine [7], and morphine [8]. Tramadol [9,10], fentanyl [8], and remifentanil patient-controlled analgesia [11] are also utilised as labour pain relievers.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacological labour pain interventions: South African midwives’ perspective

Parkies,

Murray,

Okafor

2024

BMC Nurs

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Background Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives’ perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch’s open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician’s prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives’ ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pharmacological labour pain interventions: South African midwives’ perspective

Parkies,

Murray,

Okafor

2024

BMC Nurs

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“…11 Pain causes pregnant women to experience fear and anxiety, thereby increasing stress and experiencing physiological changes during pregnancy. 12 Pain and anxiety are synergistic and exacerbate each other, a sign of discomfort in pregnant women experiencing pain in the back. 7 Back pain causes a person to experience fear and anxiety, resulting in stress during pregnancy, which has an impact on the pregnancy process.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of progressive muscle relaxation compared to BL 23 and GV 3 point acupressure therapy in reducing back pain intensity in third trimester pregnant women

Pawestri,

Yunitasari,

Khayati

et al. 2024

Scripta Medica

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Background/Aim: Back pain is one of the most common discomforts experienced by pregnant women in the third trimester of pregnancy. Interventions that can be done to overcome this are progressive muscle relaxation or acupressure at the BL 23 and GV 3 points. The aim was to determine the effectiveness of progressive muscle relaxation with BL 23 and GV 3 acupressure to reduce low back pain in third trimester pregnant women. Methods: Quasi-experimental research design method with a two-group pretest and post-test design approach was conducted. The total sample was 88 with inclusion criteria-third trimester pregnant women who experienced back pain. Pain was measured with numerical rating scale (NRS) and analysed using Wilcoxon test. Results: The average reduction in back pain for pregnant women after progressive muscle relaxation was 2.12, while the average reduction in back pain for pregnant women after BL 23 and GV 3 acupressure was 1.50. There is a mean difference between the two (0.62), so it can be concluded that there was a difference in the effectiveness of reducing back pain for pregnant women in the third trimester between the progressive muscle relaxation intervention and the respondents' pain scale after the acupressure therapy intervention at points BL 23 and GV 3. Conclusion: Back pain for pregnant women in the third trimester can be treated with progressive muscle relaxation therapy or acupressure at points BL 23 and GV 3 to reduce back pain. Progressive muscle relaxation therapy was more effective. Progressive muscle relaxation can be done by pregnant women themselves when back pain occurs.

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“…Nevertheless, the theoretical and reported growing practical evidence speaks in favour of safe remifentanil use during labour if the established standard procedure is followed, as was recently reported by the authors from RemiPCA SAFE Network (5). Although many obstetric clinics already routinely offer an option of remifentanil as the most effective alternative technique to epidural analgesia (10), a clear consensus about its safe applicability for this indication has not been reached (11,12), and additional research is necessary to determine the safety of remifentanil treatment during labour (13).…”

Section: Introductionmentioning

confidence: 99%

Determination of remifentanil in neonatal dried blood spots by liquid chromatography-tandem mass spectrometry

Trontelj,

Rozman,

Mrhar

2024

Acta Pharmaceutica

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Remifentanil is an ultra-short-acting synthetic opioid-class analgesic which might be increasingly used “off-label” as pain management during labour. Side effects in parturients during labour, and in the infant at birth are of particular concern, especially respiratory depression which is concentration-dependent, and can occur at levels as low as 3–5 ng mL–1. The safety of such use, particularly in newborns due to remifentanil placental transfer, has not been fully demonstrated yet, partly due to the lack of a suitable non-invasive analytical method. The aim of our work was to develop a sensitive method to monitor the levels of remifentanil in neonates by a non-invasive sampling of umbi lical cord blood to support efficacy and safety trials. The presented LC-MS method is sensitive enough to reliably quantify remifentanil in just 20 µL of blood at only 0.3 ng mL–1. The dried blood spot sample preparation included solvent extraction with subsequent solid-phase extraction. The method was validated in terms of accuracy, precision, recovery, matrix effect, and stability, and was successfully applied to a small pilot study. The estimated arterial blood concentrations at the time of delivery ranged from 0.2 to 0.3, and up to 0.9 ng mL–1 in neonatal, and maternal samples, respectively.

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Beyond the epidural: Alternatives to neuraxial labor analgesia

Cited by 10 publications

References 61 publications

Pharmacological labour pain interventions: South African midwives’ perspective

Pharmacological labour pain interventions: South African midwives’ perspective

Effectiveness of progressive muscle relaxation compared to BL 23 and GV 3 point acupressure therapy in reducing back pain intensity in third trimester pregnant women

Determination of remifentanil in neonatal dried blood spots by liquid chromatography-tandem mass spectrometry

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