Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice

Tuckey, J.; Prout, Rachel; Wee, M.Y.K.

doi:10.1016/j.ijoa.2007.05.014

Cited by 36 publications

(22 citation statements)

References 48 publications

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“…Units usually co-administer antiemetics (73.7%) with IM opioids. 11 Tramadol, meptazinol and pentazocine are not widely used in the UK and there is no current evidence that they confer any advantage over pethidine.…”

Section: Learning Objectivesmentioning

confidence: 99%

Non-neuraxial analgesia in labour

Robinson¹,

Howie²

2016

Anaesthesia & Intensive Care Medicine

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Pain in labour is often described as one of the most severe pains experienced. Neuraxial techniques provide the most effective form of labour analgesia. However, not all women wish to have this or indeed want complete pain relief in labour. There are also subgroups of women in whom neuraxial techniques are contraindicated or attempted placement is unsuccessful. Therefore delivery units must be able to offer a range of non-neuraxial analgesia options for labour. Royal College of Anaesthetists CPD Matrix: 1A02, 1D02, 2B01Women in labour expect to have effective analgesia and are disappointed when this is not the case. The degree of analgesia desired varies widely, with two-thirds of women questioned wanting the minimum amount of drugs to allow them to cope with the pain of labour. 1 It is therefore important that we are able to offer a range of analgesic options and ensure we give goodquality information about the different options available to aid women in making a choice most appropriate to their needs. This article will focus on non-neuraxial techniques of analgesia: non-pharmacological and pharmacological (Table 1). Non-pharmacologicalLabouring women use a range of non-pharmacological techniques for pain relief with varying effects and evidence for their use. There is some evidence to support the use of relaxation, immersion in water, acupuncture and massage, but insufficient evidence for the use of transcutaneous electrical nerve stimulation (TENS), sterile water injections, aromatherapy, biofeedback and hypnotherapy. 2 Even the techniques with poor evidence of efficacy are found useful by many women and can improve maternal satisfaction. RelaxationRelaxation techniques (breathing exercises) are often taught in antenatal classes. By focussing on breathing, it helps women to stay in control and conserve energy. Relaxation techniques are thought to provide analgesia and better maternal satisfaction with childbirth. 3

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Section: Learning Objectivesmentioning

confidence: 99%

Non-neuraxial analgesia in labour

Robinson¹,

Howie²

2016

Anaesthesia & Intensive Care Medicine

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“…Systemic opioid analgesics continue to be used in labour although practice varies, as there are insufficient data to evaluate the comparative efficacy and safety of different opioids (Tuckey et al, 2008 Level IV). IM tramadol provided similar pain relief to pethidine in the first stage of labour, but pain scores remained high in both groups and side effects were more common following tramadol (Khooshideh & Shahriari, 2009 Level II).…”

Section: Systemic Analgesia In Labour Painmentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…One study suggested improved analgesia when compared to meperidine although this was underpowered [ 26 ]. Diamorphine is used in 34 % of UK units and is now the second most common opioid used for labor analgesia after meperidine [ 27 ].…”

Section: Diamorphinementioning

confidence: 99%

Peri-delivery Analgesia and Anesthesia in Women with Hemostatic or Thrombotic Disorders

Emanuel-Kole

Bell

2015

Disorders of Thrombosis and Hemostasis in Pregnancy

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It is well recognised that labor is painful. Analgesia is therefore required by the vast majority of parturients during labor and delivery. Central neuraxial blockade is the most effective form of analgesia in labor and also the most desirable type of anesthesia for peripartum operative interventions. Inadequate hemostasis is a contraindication to central neuraxial blockade. This chapter will discuss all forms of analgesia available to the laboring woman with a hemostatic or thrombotic disorder, and the implications of abnormalities of hemostasis, with particular emphasis on central neuraxial blockade.

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Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice

Cited by 36 publications

References 48 publications

Non-neuraxial analgesia in labour

Non-neuraxial analgesia in labour

Safety of opioid patch initiation in Australian residential aged care

Peri-delivery Analgesia and Anesthesia in Women with Hemostatic or Thrombotic Disorders

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