Parenteral opioids for maternal pain management in labour

Ullman, Roz; Smith, L. A.; Burns, Ethel; Mori, Rintaro; Dowswell, Therese

doi:10.1002/14651858.cd007396.pub2

Cited by 87 publications

(44 citation statements)

References 164 publications

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“…reported that satisfaction with postoperative pain management was influenced more by patient involvement in decision‐making and maintenance of control, than by the type of analgesia and treatment techniques. Our study showed no significant difference between groups when feelings of coping and control during labour were examined (Table ); however, these findings are consistent with other studies reporting that pethidine negatively affected maternal outcomes, including increased nausea and vomiting, sedation, length of labour, and the woman's ability to adopt upright positions . In contrast, fentanyl administered via alternative routes was well tolerated and provided effective pain relief with few adverse effects: a finding consistent with our study.…”

Section: Discussionsupporting

confidence: 91%

“…Norpethidine has been associated with neuronal depression in the neonate for up to 60 hours after birth . There are few alternative pharmacological options for women, with choice limited to what is held at the different hospitals . Although research suggests that women experience superior satisfaction in pain management in labour with the use of opioids compared with non‐opioids, practitioners continue to debate which opioid and mode of administration is most effective …”

Section: Introductionmentioning

confidence: 99%

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A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial

Fleet

Belan

Jones

et al. 2015

BJOG

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Objective To compare the efficacy of fentanyl administered via the subcutaneous (s.c.) or intranasal (i.n.) route with intramuscular (i.m.) pethidine in labouring women requesting analgesia.Design A randomised controlled trial three-armed, parallel-design.Setting A regional hospital and the largest tertiary maternity centre in South Australia.Sample One hundred and fifty-six healthy parturients birthing at term.Methods Women were randomised to receive s.c. fentanyl (n = 53), i.n. fentanyl (n = 52), or i.m. pethidine (n = 51). The outcomes were analysed by intention-to-treat.Main outcome measures Pain scores measured before and 30 minutes after opioid administration.Results All groups reported clinically significant reductions in pain scores (mean range 1.2-1.6; P < 0.001), with no significant differences between groups. Significantly more women in the fentanyl groups reported satisfaction with using the study drug again, compared with women receiving i.m. pethidine (82.9% i.n. fentanyl, 80.6% s.c. fentanyl, and 44.0% i.m. pethidine; P < 0.01). Women in the fentanyl groups experienced less sedation (i.n. fentanyl 7.3%, s.c. fentanyl 2.9%, i.m. pethidine 44%; P ≤ 0.03), shorter labours by at least 2 hours (P < 0.05), and fewer difficulties establishing breastfeeding (78.8% i.m. pethidine, 39.4% i.n. fentanyl, and 44.0% s.c. fentanyl; P < 0.01). Neonates in the pethidine group were more likely to require nursery admission (P < 0.02).Conclusions Fentanyl administered by s.c. and i.n. routes is as efficacious in relieving labour pain as i.m. pethidine, but resulted in greater satisfaction, less sedation, shorter labour, fewer nursery admissions, and fewer difficulties in establishing breastfeeding. Fentanyl appears to be a suitable alternative to pethidine when providing parenteral pain relief to labouring women.Keywords Fentanyl, intramuscular, intranasal, labour, pethidine, subcutaneous.Please cite this paper as: Fleet J, Belan I, Jones MJ, Ullah S, Cyna AM. A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial. BJOG 2015;122:983-992.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial

Fleet

Belan

Jones

et al. 2015

BJOG

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“…To allow women to make informed choices concerning pain relief, larger trials are needed . Recently, we published the RAVEL study that compared RPCA and EA for satisfaction with pain relief among women with a medium to high obstetric risk.…”

Section: Introductionmentioning

confidence: 99%

Labour pain with remifentanil patient‐controlled analgesia versus epidural analgesia: a randomised equivalence trial

Logtenberg

Rengerink

Verhoeven

et al. 2016

BJOG

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“…A recent Cochrane Review has been published looking at the effectiveness and side effects of intrapartum parenteral opioids. 18 Short-term follow-up studies did not show sequelae in children in their development up to 5 years. 19e22 We investigated the association between PethidineÒ use and the risk on smoking, drinking alcohol or drug abuse in offspring 20 years after birth.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 86%

Parenteral Pethidine for labour pain relief and substance use disorder: 20-year follow-up cohort study in offspring

et al. 2012

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ObjectiveTo determine whether use of intrapartum Pethidine pain analgesia increases the risk for substance use disorder in adult offspring.DesignAnalysis of data from a cohort study.SettingAcademic hospital in Leiden, the Netherlands.Participants133 cases and 164 control individuals, aged 18–20 years at follow-up.Main outcome measureIncidence of substance use disorder or use of alcohol and tobacco.ResultsThe lifetime use of addictive substances in children exposed to intrapartum Pethidine analgesia was 45% of 133 children versus 48% of 164 not-exposed subjects (adjusted OR=0.79, 95% CI 0.48 to 1.29). Recent use of alcohol, tobacco and hard drugs showed no statistical difference either.ConclusionPethidine for labour pain medication appears not to be associated with substance misuse or smoking in later life.

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Parenteral opioids for maternal pain management in labour

Abstract: Background-Parenteral opioids are used for pain relief in labour in many countries throughout the world.

Cited by 87 publications

References 164 publications

A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial

A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial

Labour pain with remifentanil patient‐controlled analgesia versus epidural analgesia: a randomised equivalence trial

Parenteral Pethidine for labour pain relief and substance use disorder: 20-year follow-up cohort study in offspring

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