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Meta-Analysis
. 2010 Sep 8:(9):CD007396.
doi: 10.1002/14651858.CD007396.pub2.

Parenteral opioids for maternal pain relief in labour

Roz Ullman  1 , Lesley A Smith, Ethel Burns, Rintaro Mori, Therese Dowswell
Affiliations
Meta-Analysis

Parenteral opioids for maternal pain relief in labour

Roz Ullman et al. Cochrane Database Syst Rev. .

Update in

Abstract

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

Objectives: To assess the acceptability, effectiveness and safety of different types, doses and modes of administration of parenteral opioids given to women in labour.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2010) and reference lists of retrieved studies.

Selection criteria: We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient controlled analgesia) for women in labour. We looked at studies comparing an opioid with placebo or another opioid.

Data collection and analysis: At least two review authors independently assessed study eligibility, collected data and assessed risk of bias.

Main results: We included 54 studies involving more than 7000 women that compared an opioid with placebo or another opioid administered intramuscularly or intravenously. The 54 studies reported on 27 different comparisons, and for many outcomes only one study contributed data. Overall the evidence was of poor quality regarding the analgesic effect of opioids, satisfaction with analgesia, adverse effects and harm to women and babies. There were few statistically significant results. Many of the studies had small sample sizes, and low statistical power. Overall, findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour, although up to two-thirds of women who received opioids reported moderate or severe pain and/or poor or moderate pain relief one or two hours after administration. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We did not have sufficient evidence to assess which opioid drug provided the best pain relief with the least adverse effects.

Authors' conclusions: Parenteral opioids provide some relief from pain in labour but are associated with adverse effects. Maternal satisfaction with opioid analgesia was largely unreported but appeared moderate at best. We did not examine the effectiveness and safety of parenteral opioids compared with other methods of pain relief in labour and this review needs to be examined alongside related Cochrane reviews. More research is needed to determine which analgesic intervention is most effective, and provides greatest satisfaction to women with acceptable adverse events for mothers and their newborns.

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Figures

Figure 1
Figure 1. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies
Figure 2
Figure 2. Risk of bias summary: review authors’ judgements about each risk of bias item for each included study
See this image and copyright information in PMC

References

References to studies included in this review

    1. Atkinson BD, Truitt LJ, Rayburn WF, Turnbull GL, Christensen HD, Wlodaver A. Double-blind comparison of intravenous butorphanol (Stadol) and fentanyl (Sublimaze) for analgesia during labor. American Journal of Obstetrics and Gynecology. 1994;171:993–8. - PubMed
    1. Bitsch M, Emmrich J, Hary J, Lippach G, Rindt W. Obstetrical analgesia with tramadol [Geburtshilfliche Analgesie mit Tramadol] Fortschritte der Medizin. 1980;98(16):632–4. - PubMed
    1. Blair JM, Dobson GT, Hill DA, Fee JPH. Patient-controlled analgesia for labor: a comparison of remifentanil and pethidine [abstract] Anesthesiology. 2001;95 Abstract no: A1063. - PubMed

    1. *

    2. Blair JM, Dobson GT, Hill DA, McCracken GR, Fee JPH. Patient controlled analgesia for labour: a comparison of remifentanil with pethidine. Anaesthesia. 2005;60:22–7. - PubMed
    1. Borglin NE, Klottrup P. Pethidine and pentazocine. A double blind investigation in obstetric material. Lakartidningen. 1971;68:41–4. - PubMed

References to studies excluded from this review

    1. Aiken RA, Cope E. The value of promazine and diazepam as adjuncts to pethidine in labour; Proceedings of 3rd International Congress on Psychosomatic Medicine in Obstetrics and Gynaecology; 1971; London, UK. 1971.pp. 241–3.
    1. Balcioglu O, Akin S, Demir S, Aribogan A. Patient-controlled intravenous analgesia with remifentanil in nulliparous subjects in labor. Expert Opinion on Pharmacotherapy. 2007;8(18):3089–96. - PubMed
    1. Balki M, Kasodekar S, Dhumne S, Bernstein P, Carvalho J. Patient-controlled analgesia with background remifentanil infusion for labor pain [abstract] Anesthesiology. 2006;104(Suppl 1):13.

    1. *

    2. Balki M, Kasodekar S, Dhumne S, Bernstein P, Carvalho JC. Remifentanil patient-controlled analgesia for labour:optimizing drug delivery regimens. Canadian Journal of Anaesthesia. 2007;54(8):626–33. - PubMed
    1. Ballas S, Toaff ME, Toaff R. Effects of intravenous meperidine and meperidine with promethazine on uterine activity and fetal heart rate during labor. Israel Journal of Medical Sciences. 1976;12:1141–7. - PubMed

Additional references

    1. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews. 2005;(4) DOI: 10.1002/14651858.CD000331.pub2. - PubMed
    1. Barragán Loayza IM, Solà I, Juandó Prats C. Biofeedback for pain management during labour. Cochrane Database of Systematic Reviews. 2011;(6) DOI: 10.1002/14651858.CD006168.pub2. - PubMed
    1. Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. American Journal of Obstetrics and Gynecology. 2002;186(5 Suppl):S94–S109. - PubMed
    1. Callister LC. Cultural meanings of childbirth. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1995;24(4):327–31. - PubMed
    1. Chamberlain G, Wraight A, Steer P. Pain ands its relief in childbirth. The results of a National Survey conducted by the National Birthday Trust. Churchill Livingstone; Edinburgh: 1993.

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