Nonregional analgesia remains the most frequently used method during labour. Intramuscular pethidine is one of most common opioids used for labour analgesia. Exclusion criteria were pethidine allergy, contraindication for vaginal delivery, use of any kind of analgesia prior to randomization, history of drug abuse, fetal death, evidence of fetal distress or antenatal diagnosis of congenital heart malformation and obstetrics complication such as antepartum hemorrhage. Because drugs such as pethidine repress the babys respiratory centre, alternative pain relief such as epidural block offers many advantages when labour is preterm. Labour was prolonged in the diamorphine group by an average of 82 minutes over the duration of labour, and also women in the pethidine group were more likely to deliver normally within the 3hour data collection window after receipt of analgesia n 101. Pethidine produces reduced gastric emptying and the risk of aspiration may be expected to increase, whether associated with pethidine induced cns depressioncoma or during or after general anaesthesia, as for example a patient in labour who proceeds to caesarean section. Entonox have been ineffective, and rapidonset analgesia is needed. Remifentanil patient controlled analgesia pca for a. Burt, rap, the fetal and maternal pharmacology of some of the drugs used for pain relief in labour, br j anaesthesia, 1971. This document is intended to be used as a guide of general nature, having regard to general circumstances. It provides effective labour analgesia following intravenous administration via a patient controlled analgesia pca pump and is maximally effective within one to two minutes, with an onset within 30 seconds. A comparison of the efficacy and safety of morphine and.
Pethidine a little shot of something not so nice aims. Pethidine is the most widely used opioid in labour and delivery but has fallen out of favour in some countries such as the united states in favour of other opioids, due to its potential drug interactions especially with serotonergics and its neurotoxic metabolite, norpethidine. Keywords diamorphine, labour analgesia, meperidine, opiate, pethidine. If any of the above apply to you or your child, please tell your doctor before being given pethidine injection. Pethidine adult page 2 of 2 adult medication monograph clinical guidelines and policies pethidine intramuscular administration in labour epidural analgesia in labour postoperative pain postoperative iv analgesia flowchart administration of epidural therapy intravenous medications procedure for reconstitution and administration. The 3rd national audit project2 in the uk showed there was an increased overall risk with the use of cses compared to epidurals. The new zealand college of midwives acknowledges that pain is a normal part of giving birth for the vast majority of women. Pethidine is comparable to morphine in its sedative and tranquillizing effects, but the analgesia and respiratory depression it produces are of shorter duration, and it induces less smooth muscle spasm. Generally a remifentanil pca should only be used on women of at least 36 weeks gestation. Labour opioid analgesia requested has not received any other opioid in labour pethidine initial pethidine dose 100mgs im 75mg if analgesia. Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour. Currently uhp do not supply tens for use in early labour. Evidence of sympathetic and motor blockade was sought.
The degree of pain relief and duration of action were assessed after various doses of epidural pethidine had been given to 12 primigravid mothers in labour. Tramadol seems to cause a shorter duration of labour and lower incidence of maternal sideeffects. Pethidine meperidine, an opioid agonist, is the most frequently used opioid. There are a number of concerns in the literature regarding the use of pethidine. Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour article pdf available in bja british journal of anaesthesia 846.
A study of pethidine kinetics and analgesia in women in labour following intravenous, intramuscular and epidural administration. Morphine preferred to pethidine due to its reduced halflife in both the woman and the baby 1 o pethidine may be associated with reduced breastfeeding success due to babys impaired. Some studies have suggested that pethidine provides little or no pain relief in labour, its main effect being to cause sedation rather than analgesia. There is also a relatively new and not widely available method of administering pethidine for pain relief in labour called patient controlled analgesia or pca.
Labour pain and pharmacological pain relief practice points. Practice points for pethidine meperidine pethidine is a synthetic opioid of intermediate lipid with opioid and local anaesthetic properties. Tramadol seems to cause a shorter duration of labour and lower incidence of maternal side. Twentyeight doses were administered and of these 50% gave good pain relief and a further 43% of doses produced some relief. Belsey em et al, the influence of maternal analgesia on neonatal behaviour. Methods the study was carried out in the emergency department of auckland hospital, an. The authors state in their conclusion that intravenous remifentanil pca halves the proportion of epidural conversions compared with intramuscular pethidine, hereby considering. Objective to compare low doses of pethidine with dipyrone in labor analgesia. It gives good analgesia in a forceps delivery, which is often necessary for premature babies to prevent any pressure on the head. The purpose of this study was to compare the efficacy, safety, and patient satisfaction of morphine with pethidine, as analgesia for renal colic in the emergency setting. Background about a third of women receiving pethidine for labour pain subsequently require an epidural, which provides effective pain relief but. Meperidine remains the most widely available, used, and investigated opioid for labour despite its sideeffects and lack of efficacy.
The effects of maternal labour analgesia on the fetus. This is an injection of the drug pethidine into your thigh or buttock to relieve pain. After an initial dose of pethidine given by an anaesthetist, a device is set up so that the woman may selfmedicate intravenously with further doses of the drug when needed via a. Epidural morphine provides high quality analgesia of long duration but is associated with a relatively high incidence of sideeffects, includ ing the risk of delayed. Pain relief in labour plymouth hospitals nhs trust. Anaesthetists need to be aware of nonregional analgesia techniques and their limitations when providing information to women. In 14 uk maternity units offering intramuscular pethidine as standard care for pain relief in childbirth, 401 women at term were randomly assigned to receive either intravenous remifentanil via a patientcontrolled analgesia pca pump or intramuscular pethidine when requesting labour analgesia.
It takes about 20 minutes to work after the injection. Intramuscular pethidine in labor pain analgesia ahmed s elhalwagy1, sameh m fathy2 and abdelghafar s dawood1 1department of obstetrics and gynecology, faculty of medicine, tanta university, egypt 2department of anesthesia and critical care, faculty of medicine, tanta university, egypt corresponding author. Pethidine has traditionally been used in labour, however morphine has fewer side effects and a shorter halflife compared to pethidine and its active metabolite norpethidine. Provides analgesia within 2030 seconds of inhalation with a maximum effect after about 45 seconds mother is taught to inhale the mixture, so that peak brain nitrous oxide concentration coincides with peak contraction pain. Intravenous paracetamol versus intramuscular pethidine in. The effects of meperidine analgesia during labor on fetal. The analgesic effect of the epidural block was significantly superior to pethidine with regard to the pain score visual analogue scale vas during the first stage of. Other medicines and pethidine injection tell your doctor, nurse or midwife if you are taking, have recently taken or.
Analgesia and anesthesia for labor and delivery glowm. The college does not advocate the use of the routine opioid analgesia for intrapartum pain relief. Pdf advances in the field of labour analgesia have tread a long journey from. However, its analgesic efficacy was not found to be as effective as pethidine, especially in the second stage of labour. Parenteral opioids intramuscular and intravenous drugs including patient. Pdf the effects of meperidine analgesia during labor on. Inhaled analgesia appears to be effective in reducing pain intensity and in giving pain relief in labour. Opioids are probably the most commonly used medications for labour analgesia. Parenteral opioids for maternal pain management in labour. Exclusion criteria were pethidine allergy, contraindication for vaginal delivery, use of any kind of analgesia prior to randomization, history of drug abuse, fetal death, evidence of fetal distress or antenatal diagnosis of congenital heart malformation and. Pethidine is preferred to morphine in the preoperative management of biliary colic and in the management of acute diverticulitis. Pethidine meperidine, an opioid agonist, is the most frequently used opioid worldwide.
Parenteral opioids provide some relief from pain in labour but are associated with adverse effects eg, maternal nausea, vomiting and drowsiness. Remifentanil patient controlled analgesia pca on labour. Pethidine has been used extensively in spinal anaesthesia and is used intramuscularly for labour analgesia. With epidural analgesia, pain scores in women during labour may be reduced compared with parenteral opioid analgesia, women may be more likely to rate pain relief as excellent or very good, and the need for any additional analgesia may be reduced all lowcertainty evidence. A comparison of tramadol and pethidine analgesia on the duration of labour. A secondary outcome for this study was to examine womens breastfeeding experiences and satisfaction with the opiate received. Several surveys have shown that the right timing and availability of analgesia independent of the mode of analgesia. N10 women in this group required a general anaesthetic to expedite the birth of the second twin williams 2003 woman retrospective cohort usa n927 women with twin pregnancy eligible for vb. Does pethidine still have a place in the management of.
Pethidine, br j ob gyn, april 1981, vol 88, pp398406. Who recommendation on opioid analgesia for pain relief. Advances in the field of labour analgesia have tread a long journey from the days. Remifentanil is a short acting opioid analgesic drug. The information presented should not be relied on as a substitute for medical advice, independent judgement or proper assessment by a doctor. Pethidine pethidine is an alternative to diamorphine during periods when diamorphine supply is low. Sometimes, less commonly, a drug called diamorphine is used. Pain relief in labour and childbirth ranzcog website. Maternal opinion about analgesia in labour and delivery. Pethidine hydrochloride injection staff characteristics registered midwife clinical details clinical situation for which medicine is to be used for the relief of pain in labour either alone or in combination with other specified drugs. A comparison of tramadol and pethidine analgesia on the.
Both the optimistic and pessimistic interpretations of the incidence of permanent harm, and paraplegia or. Both 100 mg tramadol and 50 mg pethidine provide moderate analgesia in first stage of labour. Intramuscular pethidine is the most commonly used opioid worldwide for labour analgesia and is one of the most frequently used in the uk because midwives are licensed to prescribe and administer it. Some studies have suggested that pethidine provides little or no pain relief in labour, its main effect being to cause sedation rather than analgesia 1,2. If opioid analgesia is used it should be used judiciously andwith caution. Dissanayake3 1 school of nursing, galle, 2 ursing, rathnapura 3department of health science,the3open university of sri lanka introduction labour is one of the most painful conditions and is considered to be one of the most. In the belief that morphine itself might produce better labour analgesia than pethidine, swedish investigators conducted a randomized comparison of the two, both given intravenously in repeated doses up to 0. Intravenous remifentanil patientcontrolled analgesia. Pharmacology of opioid inhibition to noxious uterine cervical distension.
1112 246 611 1489 1004 861 1150 1531 214 863 245 350 286 720 1454 1173 408 1521 515 602 341 1395 668 1368 696 1281 731 327 945 795 1301 175 1283 568