Effect of Entonox on reducing the need for Pethidine and the Relevant Fetal and Maternal Complications for Painless Labor

Abstract

BackgroundPain relief during labour is one of the major concerns in obstetrics; severe labor pain causes fear of the next pregnancy, and interferes with the mother’s family relationship.ObjectiveThe aim of this study was to evaluate the analgesic effects of Entonox during labor on reducing the need for pethidine (Meperidine) and fetal-maternal complications.MethodsThis double-blind randomized clinical trial was conducted on pregnant women who were candidates for vaginal delivery in Educational Hospitals of Mashhad University of Medical Sciences, Iran between January 2014 and November 2015. After entering into the inactive phase of labor, participants were randomly allocated to receive inhaled Entonox gas (n=200) or inhale Oxygen (n=200) as a control group. Mothers inhaled the gas at commencement of pain, and ceased as soon as the pain diminished, up to the end of the second stage of labor which was the neonate’s birth. Main outcomes were pain score based on NRS (numerical rating scale), duration of delivery, required pethidine, maternal complications and satisfaction during labour. Chi-square and Independent T-test were used via SPSS for data analysis and P-value less than 0.05 was considered statistically significant.ResultsFour-hundred pregnant women with a mean age of 26.4±5.9 years were studied. Complications such as nausea, vomiting, dizziness, and drowsiness were reported in 25% of the Entonox group and 23% in the control group (p=0.640). Mean of pain severity score during labor in the Entonox and control groups was 4.5±1.2 and 5.2±1.4, respectively (p<0.001). Pethidine requirement, significantly was lower in the Entonox group (31.6±11.8 versus 35.7±12.4; p<0.001).ConclusionIn our study, Entonox significantly reduced pain during delivery without significant increase in maternal and neonatal complications.Trial registrationThe trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2015102713159N6.FundingThis research has been financially supported by Research Council of Mashhad University of Medical Sciences.

A Randomized Controlled Trial of Entonox and Oxygen in Labor Analgesia

“…Results of a study by Attar et al revealed that patients in the Entonox group experienced less pain (p ≤ 0.001) as compared to the oxygen group and also had less duration of delivery (p ≤ 0.001). 14,16 Most of the parturients delivered vaginally with no additional requirement of augmentation with Pitocin in the Entonox group as also was noted in the study by Agah et al 15 In the present study, the majority of the laboring mother did not have any significant maternal side effects. Three patients in the Entonox group had nausea and dizziness as compared to one patient in the oxygen group who had dizziness.…”

Entonox® versus Pethidine in Labor Pain Relief: A Randomized Controlled Trial

“…For examples, Entonox ® may be used as an adjunct to pethidine to potentiate pain relief. Attar et al [ 8 ] conducted a double-blind randomized clinical trial to compare the analgesic effects of Entonox ® during labor on reducing the need for pethidine and fetal–maternal complications. They demonstrated that Entonox ® significantly reduced pain during labor without significant increase in maternal and neonatal complications.…”

Anaesthesia of pregnant women

“…Intermittent use of LIVOPAN to relieve labor pain until the end of the second stage of labor, compared to inhalation of pure oxygen, brings significant relief to the mother, reduces the need for intravenous pethidine 0.5 mg/kg and increases maternal satisfaction and is safe for the fetus [30]. The main advantages of N2O as an analgesic during labor are its favorable pharmacological profile (quick onset and rapid rinse out 30-50 s) and the possibility of inhalation by the patient herself, who controls its administration [31].…”