Labour analgesia and the baby: good news is no news

Reynolds, F.

doi:10.1016/j.ijoa.2010.08.004

Cited by 85 publications

(56 citation statements)

References 135 publications

(131 reference statements)

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“…The most common methods used for pain relief during delivery are regional anesthesia (RA) using a spinal or epidural analgesic and parenteral opioid therapy, in particular pethidine and meptazinol [1]. The opioids have been criticized because of their limited analgesic efficacy, the associated side effects such as nausea, fatigue, and the potential for maternal and neonatal respiratory depression [2,3]. The analgesic superiority of regional analgesia over parenteral opioid therapy has been sufficiently documented elsewhere in randomized studies [4,5].…”

Section: Efficacy and Effects Of Parenteral Pethidine Or Meptazinol Amentioning

confidence: 99%

Efficacy and Effects of Parenteral Pethidine or Meptazinol and Regional Analgesia for Pain Relief during Delivery. A Comparative Observational Study

Singer

Jank

Amara

et al. 2016

Geburtshilfe Frauenheilkd

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Hintergrund: Parenterale Opioide und Regionalanalgesie stellen mögliche peripartale Analgesiemethoden dar. In der Literatur liegen wenige Daten zum Vergleich der beiden Verfahren im geburtshilflichen Alltag vor. Diese Beobachtungsstudie untersucht die Opioide Pethidin und Meptazinol sowie Regionalanalgesie hinsichtlich Handhabung, Effektivität, Nebenwirkungen und subjektiver maternaler Therapiezufriedenheit. Die Rate sekundärer Regionalanalgesien nach jeweiliger Opioidgabe dient der Therapiebeurteilung. Methoden: Im 12-monatigen Studienzeitraum wurden Daten vaginaler Geburten mit entsprechenden Schmerztherapien an einem deutschen Universitätsklinikum erfasst. Die intrapartale Schmerzstärke wurde mittels numerischer Ratingskala gemessen. Mutter-, kind-und geburtsbezogene Daten wurden postpartal aus der klinischen Dokumentation und von den Müttern anhand eines Fragebogens erhoben. Ergebnisse: Die Studie umfasst Daten von 449 Entbindungen. Die Schmerzlinderung durch Pethidin und Meptazinol ist vergleichbar gering, die maternale Therapiezufriedenheit jeweils gut. Meptazinol wird häufiger intravenös (83 vs. 6 %; p < 0,001) und repetitiv (27 vs. 6 %; p < 0,001) sowie in geringerem Abstand zur Geburt verabreicht (1,9 ± 2,7 h vs. 2,6 ± 2,8 h; p < 0,05) als Pethidin. Sekundäre Regionalanalgesien sind häufiger nach Pethidingabe (16 vs. 8 %; p < 0,05). Regionalanalgesie bewirkt eine stärkere Schmerzlinderung als Opioidtherapie (78 vs. 24 % nach 30 min; p < 0,001) bei längerem Geburtsverlauf (7,6 ± 2,5 h vs. 5,7 ± 2,5 h; p < 0,001) und höherer maternaler Therapiezufriedenheit (6,1 ± 1,2 vs. 4,8 ± 1,6 auf einer 7-Punkte-Skala; p < 0,001). Schlussfolgerung: Im klinischen Alltag kann Meptazinol besser an den Geburtsverlauf adaptiert werden und macht weniger sekundäre Re

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Section: Efficacy and Effects Of Parenteral Pethidine Or Meptazinol Amentioning

confidence: 99%

Efficacy and Effects of Parenteral Pethidine or Meptazinol and Regional Analgesia for Pain Relief during Delivery. A Comparative Observational Study

Singer

Jank

Amara

et al. 2016

Geburtshilfe Frauenheilkd

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“…4,64 Potential maternal side effects include hemodynamic instability and pruritus, as well as nausea/vomiting, urinary retention, respiratory depression, 3,4,58,[71][72][73][74] and impaired breast feeding. 4,47,52,70,[75][76][77] Epidural associated fever is still discussed, but so far without evidence. 3,4,52,78,79 Regarding neonatal outcome the overall effect of EDA is positive.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…3,4,52,78,79 Regarding neonatal outcome the overall effect of EDA is positive. 50,70,80 Complications to epidural may occur; accidental perforation of dura with post dural puncture headache being the most frequent. More serious complications as intraspinal or intravenous injection of epidural drugs, neurological injury and sequeles, epidural hematoma and epidural infection have been reported, although rare.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…Nitrous oxide is the only inhalational analgesia that has reached widespread use for alleviation of labour pain, 14,31,70 although more potent agents have also been used. 14,17,31,98 Nitrous oxide has been used in labour since the late 1800s, and equipment for selfadministration was introduced by Minnitt in England in 1934.…”

Section: Nitrous Oxidementioning

confidence: 99%

“…In a global perspective, it is regarded as an atmospheric polluter, and the use should therefore be restricted. 70 …”

Section: Nitrous Oxidementioning

confidence: 99%

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Remifentanil as analgesia for labour pain

Tveit

2013

Acta Anaesthesiol Scand

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Background To collect updated information about pharmacological labour analgesia in Norway, especially systemic opioids and epidural. Evaluation of efficacy and safety with remifentanil intravenous patient‐controlled analgesia (IVPCA) for pain relief during labour. To compare remifentanil IVPCA with epidural analgesia (EDA) regarding efficacy and safety during labour. Methods In paper I, two national surveys identified Norwegian labour analgesia methods and changes during the study period (2005–2008). Paper II is a prospective, observational study of analgesic efficacy and safety with remifentanil IVPCA. Paper III is a prospective, randomized controlled trial comparing remifentanil IVPCA with EDA regarding analgesic efficacy and safety. Results The surveys in paper I found the frequency of EDA in Norwegian hospitals to be increasing, but still low (25.9%) compared with other western countries. Nitrous oxide and traditional systemic opioids, like pethidine, were frequently used. In paper II, remifentanil IVPCA was found to give satisfactory labour analgesia in more than 90% of the parturients with an average maximal pain reduction of 60%. Maternal oxygen desaturation and sedation were acceptable, and neonatal data reassuring. In paper III, a randomized controlled trial found remifentanil IVPCA and EDA to be comparable both regarding analgesic efficacy (pain reduction; Fig. ) and maternal satisfaction. Remifentanil IVPCA produced more maternal sedation and oxygen desaturation; neonatal outcome was reassuring in both groups. Reduction in pain score [visual analogue scale (VAS)] during labour analgesia with patient‐controlled intravenous remifentanil and continuous epidural infusion with ropivacaine and fentanyl. Conclusion The frequency of epidural labour analgesia in Norway has increased, but is still relatively low. Nitrous oxide and traditional systemic opioids are frequently used. The clinical practice seems conservative; newer short‐acting opioids are seldom used for systemic labour analgesia. The studies on remifentanil IVPCA revealed adequate pain relief, high maternal satisfaction, and no serious neonatal side effects. There were no differences in analgesic efficacy, maternal satisfaction, and neonatal outcome when comparing remifentanil IVPCA with EDA. However, remifentanil caused maternal sedation and oxygen desaturation. We recommend the use of IVPCA remifentanil as labour analgesia instead of traditional opioids as pethidine and morphine when EDA is not an option. The presence of skilled personnel and close monitoring is mandatory.

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