Main Article Content
Analgesia, Active Phase, Pain, Pethidine, Labor
Background: Opioid analgesics had been used from time to time for treating labor pain. However, their use have been concerning. The aim of this study is to evaluate the effect of pethidine on duration of active phase of labor, labor pain and maternal-neonatal outcomes.
Methods: In the present case-control study, the study group received a 50 mg pethidine intramuscular injection upon the start of active phase of labor, and the control group consisted of patients who receive placebo injeciton. In both groups, vital signs were measured before, and at 0, 5, 15, 30, 45 and 60 minutes after the injection. Pain intensity was evaluated with Visual Analogue Scale (VAS) prior to, and 1 hour and 2 hours after injection. Data regarding labor phase durations, maternal side effects, newborn APGAR scores and fetal respiratory problems were recorded.
Results: 102 patients in Pethidine group and 92 patients in control group, were included into the study. Labor pain VAS-scores were significantly lower in the study group (p<0.001). Moreover, active phase of labor duration was significantly shorter in the study group (p<0.001). Maternal pulse significantly decreased, and maternal nausea-vomiting was frequent in the study groups. However, the groups were similar in terms of other side effects and neonatal outcomes.
Conclusions:Pethidine significantly reduces active phase of labor duration, has a favorable analgesic effect in treating labor pain and is not associated with serious maternal or neonatal complications. It is therefore considered an acceptable agent for use during active phase of labor.
2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse D, Spong CY. Williams obstetrics. In: Obstetrical anasthesia. 23th ed. McGraw-Hill: 2010.
3. Keskin HL, Keskin EA, Avsar AF, Tabuk M, Caglar GS. Pethidine versus tramadol for pain relief during labor. Int J Gynecol Obstet 2003;82(1):11–6. doi:10.1016/s0020-7292(03)00047-
4. Mirzaii F, Kaviani M, Jafari P. Evaluation of effect of foot reflexology in labor pain and duration of the first stage of labor. Iranian Journal of Obstetrics Gynecology and Infertility 2010;13(1):27-32. PMC3371987
5. Kordi M, Rohani S, Fadii AR, Esmaili H. Effect of pressure on point of 6th spleen in labor pain in the first stage of labor. Iranian Journal of Obstetrics Gynecology and Infertility 2009;26(4):7-12.
6. Fleet J, Jones M, Belan I. Taking the alternative route: women’s experience of intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia. Midwifery 2017;53:15–9. doi:10.1016/j.midw.2017.07.006
7. Posnenkova OM, Kiselev AR, Gridnev VI, Popova YV, Shvartz VA. View on the problem of managing of medical care quality. Oman Med J 2012;27(3):261-262. doi:10.5001/omj.2012.63
8. Pandya ST. Labour analgesia: Recent advances. Indian J Anaesth 2010;54(5): 400–8. doi:10.4103/0019-5049.71033
9. Smith LA, Burns E, Cuthbert A. Parenteral opioids for maternal pain management in labour. Cochrane Database Syst Rev. 2018;6(6):CD007396. Published 2018 Jun 5. doi:10.1002/14651858.CD007396.pub3
10. Watts R. Does pethidine still have a place in the management of labour pain? Aust Prescr. 2004;27:34-35. DOI: 10.18773/austprescr.2004.034
11. Molloy A. Does pethidine still have a place in therapy? Aust Prescr 2002;25:12-3. DOI: 10.18773/austprescr.2002.008
12. Kamyabi Z, Naderi T, Ramazani A. A randomized, placebo-controlled trial of the effects of pethidine on labor pain, uterine contractions and infant Apgar score. Ann Saudi Med 2003;23(5):318–20. DOI: 10.5144/0256-4947.2003.318
13. Prasertsawat PO, Herabutya Y, Chaturachinda K. Obstetric analgesia: comparison between tramadol, morphine and pethidine. Curr Therapeut Res 1986;40(6):1022 –1028.
14. Fieni S, Angeri F, Kaihura CT, et al. Valutazione degli effetti peripartum di due analgesici, meperidina e tramadolo, utilizzati in travaglio di parto [Evaluation of the peripartum effects of 2 analgesics: meperidine and tramadol, used in labor]. Acta Biomed Ateneo Parmense. 2000;71 Suppl 1:397-400.
15. Bredow V. The use of tramadol-versus pethidine-versus denaverin suppositories under labour. Zentralbl Gynecol. 1992;114 (11):551-554.
16. Douma M.R, Verwey R.A, Kam-Endtz C.E, van der Linden P.D, Stienstra R. “Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour”. Br. J. Anaesth., 2010 Feb;104(2):209-15. doi: 10.1093/bja/aep359.
17. Olofsson C, Ekblom A, Ekman-ordeberg. Lack of analgesic effect of systematically administered morphine and pethidine on labour pain. Br J Obstet Gynecol. 1996;103(10):968-972. doi:10.1111/j.1471-0528.1996.tb09545.x
18. Elbohoty AEH, Abd-Elrazek H, Abd-El-Gawad M, Salama F, El-Shorbagy M, Abd-El-Maeboud KHI. Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor . International Journal of Gynecology and Obstetrics 2012;118:7–10. doi:10.1016/j.ijgo.2012.01.025
19. Thurlow JA, Laxton CH, Dick A, Waterhouse P, Sherman L, Goodman NW. Remifetanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour. Br J Anaesth 2002;88(3):374–8. doi:10.1093/bja/88.3.374
20. Fleet J, Jones M, Belan I. Subcutaneous administration of fentanyl in childbirth: An observational study on the clinical effectiveness of fentanyl for mother and neonate. Midwifery. 2014;30(1):36-42. doi: 10.1016/j.midw.2013.01.014.
21. Fleet J, Belan I, Jones MJ, Ullah S, Cyna AM. A comparison of fentanyl with pethidine for pain relief during childbirth: randomised controlled trial. BJOG 2015;122:983–92. doi:10.1111/1471-0528.13249
22. Marwah R, Samah Hassan S, Carvalho JA, Balki M. Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study. Can J Anesth 2012;59:246-254.24. doi:10.1007/s12630-011-9625-0
23. Shoorab N.J, Ebrahimzadeh Zagami S, Mirzakhani K, Mazlom S.R. The Effect of Intravenous Fentanyl on Pain and Duration of the Active Phase of First Stage Labor. Oman Medical Journal 2013;28(5):306-310. doi:10.5001/omj.2013.92
24. Goodman and Gilman's. The pharmacological basis of therapeutics. McGraw-Hill Companies lnc:1991;485-520.
25. Rang HP, Pale MM. Pharmacology. Churchill Livingstone: 1987;553-566.
26. Chestnut DH. Obstetric anesthesia principles and practice. Mosby Inc: 1994;340-352.
27. Reynolds F. The effects of maternal labour analgesia on the fetus. Best Pract Res Clin Obstet Gynaecol. 2010;24(3):289-302. doi: 10.1016/j.bpobgyn.2009.11.003.
28. Tsui MH, Ngan Kee W, Ng F, Lau T. A double blinded randomised placebo-controlled study of intramuscular pethidine for pain relief in the first stage of labor. BJOG. 2004 Jul;111(7):648-55. doi:10.1111/j.1471-0528.2004.00160.x
29. Lieberman B, Rosenblatt D, Belsey E, et al. The effect of maternally administered pethidine or epidural bupivacaine on the fetus and newborn. Br J Obstet Gynaecol. 1979;86(8):598-606. doi:10.1111/j.1471-0528.1979.tb10820.x
30. Halina K, Brygida J, Beata C.M. Pethidine for labor analgesia; monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after the delivery. Ginekol Pol. 2012;83(5):357-62.