Inhaled analgesia for pain management in labour

Klomp, Trudy; Poppel, Mireille van; Jones, Leanne; Lazet, Janine; Nisio, Marcello Di; Lagro-Janssen, Antoine L. M.

doi:10.1002/14651858.cd009351.pub2

Cited by 71 publications

(44 citation statements)

References 82 publications

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“…The study conducted by Berlit et al showed that in 45% of the cases, entonox had no side effects, and in the rest of the cases, the side effects of entonox included dizziness (35%), euphoria (31%), and nausea (4%), all of which were transient and this is consistent with the result of this study (19). Similar studies have reported side effects such as dry mouth, dizziness, drowsiness and nausea (24,25). In the N 2 O group, the duration of episiotomy repair was significantly lower in comparison with the lidocaine group.…”

Section: Discussionsupporting

confidence: 90%

Nitrous Oxide Versus Lidocaine for Pain Relief During Episiotomy Repair: A Randomized Trial

Javadifar¹,

Honarmandpour²,

Abbaspoor³

et al. 2017

International Journal of Women’s Health and Reproduction Scienc

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Materials and Methods Study Design and ParticipantsThis prospective randomized controlled clinical trial was conducted on primiparous women who attended a referring academic hospital in the southwest of Iran (Shushtar). Inclusion criteria were: Primipara women between 39 to 42 weeks of gestation according to sonographic findings or last menstrual period date, AbstractObjectives: Since pain reduction is an important concern in childbirth, this study was designed to evaluate the effects of nitrous oxide in comparison with lidocaine on pain relief, during episiotomy repair in primiparous women. Materials and Methods: A prospective randomized controlled trial method was used in this study and 120 term pregnant women were recruited. The intervention group received nitrous oxide 2 minutes before starting episiotomy repair, until the end of the procedure. The control group received 5 mL of lidocaine (2%) before starting the episiotomy. The results of the 2 groups were compared with regard to pain intensity using a visual analogue scale (VAS). Mann-Whitney, student's t test and chi-square test were used to analyze the data. Results: Sixty women were studied in each group. Nine participants (15%) in nitrous oxide group, as opposed to 23 participants (38.4%) in lidocaine group had moderate, severe or extremely severe pain intensity (P value = 0.005). In terms of satisfaction level, there was no significant difference between 2 groups (P value = 0.713). Conclusion:The results of this study showed that pain intensity in the nitrous oxide group was significantly lower than that in the lidocaine infiltration group. Application of nitrous oxide at least 2 minutes before repair may be an effective method for pain management in episiotomy repair.

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Section: Discussionsupporting

confidence: 90%

Nitrous Oxide Versus Lidocaine for Pain Relief During Episiotomy Repair: A Randomized Trial

Javadifar¹,

Honarmandpour²,

Abbaspoor³

et al. 2017

International Journal of Women’s Health and Reproduction Scienc

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“…The study of Berlit et al showed that Entonox was 45% without side effects, dizziness (35%), euphoric (31%), and nausea (4%) which are all transient and this was consistent with the result of this study (19). Similar studies reported side effects such as dry mouth, dizziness, drowsiness, and nausea (24,25).…”

Section: Discussionsupporting

confidence: 89%

Nitrous Oxide Versus Lidocaine for Pain Relief During Episiotomy Repair: A Randomized Trial

Javadifar¹,

Honarmandpour²,

Abbaspoor³

et al. 2017

International Journal of Women’s Health and Reproduction Scienc

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“…Recently, the existing body of evidence with respect to nitrous oxide and other inhaled molecules have been subjected to a systematic review in which the authors concluded that “Inhaled analgesia appears to be effective in reducing pain intensity and in giving pain relief in labour” [17]. However, these conclusions have been based mainly on the fact that placebo, sham-treatment or no treatment provided less pain relief compared to nitrous oxide (average RR 0.06, 95% CI 0.01 to 0.34, two studies, 310 women; MD −3.50, 95% CI −3.75 to −3.25, one study, 509 women).…”

Section: Discussionmentioning

confidence: 99%

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Kranke

Girard

Lavand’homme

et al. 2013

BMC Pregnancy Childbirth

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BackgroundThe epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units.Since the end of the 90ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don’t want, can’t have or don’t need epidural analgesia.DiscussionIn view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions.However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a “poor man’s epidural” and to safely administer remifentanil with an appropriate indication.SummaryTherefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia.

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Inhaled analgesia for pain management in labour

Cited by 71 publications

References 82 publications

Nitrous Oxide Versus Lidocaine for Pain Relief During Episiotomy Repair: A Randomized Trial

Nitrous Oxide Versus Lidocaine for Pain Relief During Episiotomy Repair: A Randomized Trial

Nitrous Oxide Versus Lidocaine for Pain Relief During Episiotomy Repair: A Randomized Trial

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

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