Parenteral opioids for maternal pain relief in labour

Ullman, Roz; Dowswell, Therese; Mori, Rintaro

doi:10.1002/14651858.cd007396

Cited by 35 publications

(61 citation statements)

References 19 publications

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“…1 Butorphanol, tramadol, nalbuphine, morphine, fentanyl, and remifentanil have also been used for labour analgesia; however, there is no clear evidence that any one drug is superior to any other. 2 Fentanyl and remifentanil are more popular for this indication as their pharmacokinetic and pharmacodynamic characteristics are favourable to meeting the intensity and undulating characteristics of labour pain.…”

Section: Résumémentioning

confidence: 99%

Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

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Purpose We undertook a retrospective study to compare the analgesic efficacy and effects on neonatal outcome of administering either remifentanil or fentanyl intravenous patient-controlled analgesia (IVPCA) during labour. Methods A five-year retrospective cohort study was undertaken of women with more than 24 weeks of gestation who had received either IVPCA remifentanil or fentanyl for labour analgesia at Mount Sinai Hospital. The sampling timeframe was from November 2005 to March 2010. The standard IVPCA regimen for the remifentanil group consisted of a PCA bolus 0.25 lgÁkg -1 with a lockout interval of two minutes, a four-hour limit of 3 mg, and a background infusion of 0.025-0.05 lgÁkg -1 Ámin -1 , whereas the standard IVPCA regimen for the fentanyl group consisted of a PCA bolus 25-50 lg with a lockout interval of three to six minutes and a four-hour limit of 1-1.5 mg. The following data were compared: maternal hourly pain scores (verbal pain score scale 0-10), sedation scores (scale 0-3), adverse effects, and neonatal outcomes. Mixed linear modelling was used to analyze longitudinal data on pain scores over time. The exact Wilcoxon test and the Fisher's exact test were used for other comparisons.Results Ninety-eight women were studied. There was no significant difference in the model-adjusted pain scores between the two groups (P = 0.86). There was a moderate decrease in pain scores in both groups compared with the baseline values. There was no difference in maternal side effects between the two groups, although transient oxygen desaturation was observed more frequently in the remifentanil group than in the fentanyl group (13% vs 2%, respectively; odds ratio, 7.32; 95% confidence interval [CI], 0.85 to 63.3). A larger number of neonates in the fentanyl group required resuscitation compared with neonates in the remifentanil group (59% vs 25%, respectively; odds ratio, 4.33; 95% CI, 1.75 to 10.76); adjusted (44% vs 8%, respectively; odds ratio, 8.56; 95% CI, 2.17 to 33

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Section: Résumémentioning

confidence: 99%

Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

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“…The bio-medical model of care has resulted in the medicalisation of childbirth with increasing rates of epidural anaesthesia, particularly during normal labour (Walsh, 2012), embodying the pre-conceived assumption of pain implying suffering and requiring elimination (Simkin and Bolding, 2004). The administration of opioids during childbirth may offer some efficiency in pain relief, however, undesirable effects such as maternal nausea, drowsiness (Ullman et al, 2010) and potential compromise to the baby, causes concern about advocating their routine use (Heelbeck, 1999).…”

Section: Introductionmentioning

confidence: 99%

Women׳s experiences of coping with pain during childbirth: A critical review of qualitative research

Gucht¹,

Lewis²

2015

Midwifery

109

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Objective: to identify and analyse qualitative literature exploring women's experiences of coping with pain during childbirth. Design: critical review of qualitative researchFindings: Ten studies were included, conducted in Australia, England, Finland, Iceland, Indonesia, Iran and Sweden. Eight of the studies employed a phenomenological perspective with the remaining two without a specific qualitative methodological perspective. Thematic analysis was used as the approach for synthesising the data in this review. Two main themes emerged as the most significant influences upon a woman's ability to cope with pain: (i) the importance of individualised, continuous support and (ii) an acceptance of pain during childbirth.This review found women felt vulnerable during childbirth and valued the relationships they had with health professionals. Many of the women perceived childbirth pain as challenging however they described the inherent paradox for the need for pain to birth their child. This allowed them to embrace the pain subsequently enhancing their coping ability.Key conclusions: women's experience of coping with pain during childbirth is complex and multi-faceted. Many women felt the need for effective support throughout childbirth and described the potential implications where this support failed to be provided. Feeling safe through the concept of continuous support was a key element of care to enhance coping ability and avoid feelings of loneliness and fear. A positive outlook and acceptance of pain was acknowledged by many of the women, demonstrating the beneficial implications for coping ability. These findings were consistent despite the socio-economic, cultural and contextual differences observed within the studies suggesting experiences of coping with pain during childbirth are universal. Implications for practice:

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“…No such risk has been described for meptazinol. The data comparing different parental opioids with respect to maternal satisfaction with therapy is generally unsatisfactory [17]. Our study showed that maternal satisfaction with pethidine therapy was comparable with satisfaction with meptazinol therapy in clinical practice.…”

mentioning

confidence: 53%

“…In the literature the analgesic effect of both opioids is usually classified as equivalent and as generally low, although sometimes meptazinol is judged to have a better side effects profile with less neonatal respiratory depression [15,16]. Very few studies have looked at maternal satisfaction with parenteral opioid therapy and, on investigation, the opioids are generally found to be comparable [17]. A comprehensive evaluation of pain management therapies should include the effects of therapy on maternal birth experience, as it does not necessarily depend on the extent of pain relief [18].…”

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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Parenteral opioids for maternal pain relief in labour

Abstract: Analysis 14.2. Comparison 14 IM tramadol versus no treatment, Outcome 2 Mean blood loss at delivery (ml).. . Analysis 15.1. Comparison 15 IM Avacan ® versus IM pentazocine, Outcome 1 Further analgesia required (nitrous oxide

Cited by 35 publications

References 19 publications

Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study

Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study

Women׳s experiences of coping with pain during childbirth: A critical review of qualitative research

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

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