Review of Opioid Pca for Labour Analgesia

Hill, David A.; McMACKIN, Paul

doi:10.1017/s0965539512000010

Cited by 2 publications

(3 citation statements)

References 58 publications

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“…Most studies were single-arm trials carried out between the 1940s and 1960s which makes the quality and relevance of their results questionable. Some authors concluded from these studies that pethidine shortened labour, others claimed it lengthened labour, and still others decided it did both, depending on which stage of labour it was given (Thomson & Hillier, 1994;Crafter, 2000;Hill & McMackin, 2012). A letter to the editor of the British Medical Journal in July 1947 conveys the most commonly held theory that had emerged by this time -that pethidine relaxed women enabling labour to progress.…”

Section: Pethidine Use To Shorten Labourmentioning

confidence: 99%

“…Pethidine readily crosses the placenta with maximum levels found in the baby's bloodstream between one and five hours following maternal administration (Tuckey, Prout & Wee, 2007). Fetal effects include reduced short term beat-to-beat variability of the fetal heart and neonatal effects include reduced Apgar scores, depressed muscle tone, respiratory effort, and sucking ability (Reynolds, 2010;Hill & McMackin, 2012). Other studies have raised additional concerns regarding the potential association between use of opioids in labour and development of neonatal drug dependency in later life, though this has not been proven (Nyberg, Allebeck, Eklund & Jacobson, 1993;El-Wahab & Robinson, 2011;Jacobson et al, 1990;Nyberg et al, 2000).…”

Section: Significant Fetal and Neonatal Concernsmentioning

confidence: 99%

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Pethidine: To prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation

Goodson¹,

Martis²

2014

nzcomjnl

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Changes to the New Zealand Misuse of Drugs Act (1975) regarding the prescription of opioids by midwives are currently under discussion. At this time, pethidine is the only controlled drug able to be prescribed by New Zealand midwives. Pethidine is a synthetic opioid which affects the transmission of pain signals to the central nervous system and induces a state of euphoria and sleepiness. It was first used in midwifery in the United Kingdom to sedate anxious women and was never intended to be prescribed for pain relief. Despite the widespread belief that pethidine is effective at reducing pain and shortening women's labours, the available evidence does not support this. Significant side effects for both the woman and the baby raise further questions about the suitability and safety of pethidine use in New Zealand maternity care. Relevant New Zealand legislation is currently under review with the potential for changes enabling midwives to offer a wider range of opioids. This article represents sections of a case study submitted as part of the requirements for the third year of study towards a Bachelor of Midwifery at Christchurch Polytechnic Institute of Technology (CPIT). It investigates the use of pethidine as a pharmaceutical method of pain relief in the New Zealand context, and the effects of its administration on the length of a woman's labour and on neonatal outcomes. Considerations for, and potential changes within, midwifery prescribing practices are then discussed

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Section: Pethidine Use To Shorten Labourmentioning

confidence: 99%

Section: Significant Fetal and Neonatal Concernsmentioning

confidence: 99%

Pethidine: To prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation

Goodson¹,

Martis²

2014

nzcomjnl

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“…Remifentanil seems to be beneficial for obstetric analgesia, and is already used in some countries. 9,15,175,184 Because of the unique pharmacokinetic properties, remifentanil has the potential to be the parenteral opioid of choice for women in labour.…”

Section: Future Perspectivesmentioning

confidence: 99%

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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Review of Opioid Pca for Labour Analgesia

Cited by 2 publications

References 58 publications

Pethidine: To prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation

Pethidine: To prescribe or not to prescribe? A discussion surrounding pethidine's place in midwifery practice and New Zealand prescribing legislation

Remifentanil as analgesia for labour pain

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