heroin and Labor-Pain

Intramuscular (i.m.) pethidine is used worldwide for labour analgesia and i.m. diamorphine usage has increased in the UK in the last 15 years. This trial aims to ascertain the relative efficacy and adverse effects of diamorphine and pethidine for labour pain.. Prospective, parallel-arm randomised controlled trial with blinding of participants, care-givers and outcome assessors.. Maternity units in two District General Hospitals in the UK.. After written informed consent, 484 women were randomised and recruited (244 diamorphine, 240 pethidine). Inclusion criteria included women 16 years or older, established labour, singleton pregnancy, 37-42 weeks of gestation and weight 60-120 kg.. On request of i.m. analgesia, participants received either 150 mg pethidine or 7.5 mg diamorphine based on computer-generated block randomisation.. Maternal-reduction in pain intensity from baseline (10-cm visual analogue scale) at 60 minutes and over the 3-hour period after drug administration. Neonatal-requirement for resuscitation and Apgar score at 1 minute.. Diamorphine provided modestly improved pain relief at 60 minutes, mean difference 1 cm (95% confidence interval [CI] 0.5-1.5), and over the 3 hours, mean difference 0.7 cm (95% CI 0.3-1.1). However, average length of labour in women receiving diamorphine was 82 minutes longer (95% CI 39-124) and therefore they experienced more pain overall. There were no statistically significant differences in primary neonatal outcomes.. There is a modest difference between the analgesia provided by diamorphine or pethidine for labour analgesia but diamorphine is associated with significantly longer labours.

Topics: Adolescent; Adult; Analgesia, Obstetrical; Analgesics, Opioid; Double-Blind Method; Drug Administration Schedule; Female; Heroin; Humans; Injections, Intramuscular; Labor Pain; Logistic Models; Meperidine; Pain Measurement; Pregnancy; Prospective Studies; Treatment Outcome; Young Adult

Intramuscular pethidine is routinely used throughout the UK for labour analgesia. Studies have suggested that pethidine provides little pain relief in labour and has a number of side effects affecting mother and neonate. It can cause nausea, vomiting and dysphoria in mothers and can cause reduced fetal heart rate variability and accelerations. Neonatal effects include respiratory depression and impaired feeding. There are few large studies comparing the relative side effects and efficacy of different opioids in labour. A small trial comparing intramuscular pethidine with diamorphine, showed diamorphine to have some benefits over pethidine when used for labour analgesia but the study did not investigate the adverse effects of either opioid.. The Intramuscular Diamorphine versus Intramuscular Pethidine (IDvIP) trial is a randomised double-blind two centre controlled trial comparing intramuscular diamorphine and pethidine regarding their analgesic efficacy in labour and their side effects in mother, fetus and neonate. Information about the trial will be provided to women in the antenatal period or in early labour. Consent and recruitment to the trial will be obtained when the mother requests opioid analgesia. The sample size requirement is 406 women with data on primary outcomes. The maternal primary outcomes are pain relief during the first 3 hours after trial analgesia and specifically pain relief after 60 minutes. The neonatal primary outcomes are need for resuscitation and Apgar Score <7 at 1 minute. The secondary outcomes are an additional measure of pain relief, maternal sedation, nausea and vomiting, maternal oxygen saturation, satisfaction with analgesia, whether method of analgesia would be used again, use of Entonox, umbilical arterial and venous pH, fetal heart rate, meconium staining, time from delivery to first breath, Apgar scores at 5 mins, naloxone requirement, transfer to neonatal intensive care unit, neonatal haemoglobin oxygen saturation at 30, 60, 90, and 120 mins after delivery, and neonatal sedation and feeding behaviour during first 2 hours.. If the trial demonstrates that diamorphine provides better analgesia with fewer side effects in mother and neonate this could lead to a change in national practice and result in diamorphine becoming the preferred intramuscular opioid for analgesia in labour.. ISRCTN14898678Eudra No: 2006-003250-18, REC Reference No: 06/Q1702/95, MHRA Authorisation No: 1443/0001/001-0001, NIHR UKCRN reference 6895, RfPB grant PB-PG-0407-13170_IR5.

Topics: Analgesia, Obstetrical; Analgesics, Opioid; Apgar Score; Cardiotocography; Double-Blind Method; Feeding Behavior; Female; Heroin; Humans; Infant, Newborn; Injections, Intramuscular; Intensive Care, Neonatal; Labor Pain; Meperidine; Nausea; Oxygen; Patient Satisfaction; Pregnancy; Resuscitation; Vomiting

Topics: Analgesia, Obstetrical; Analgesics, Opioid; Female; Heroin; Humans; Labor Pain; Meperidine; Pregnancy

Topics: Analgesia, Obstetrical; Analgesics, Opioid; Female; Heroin; Humans; Labor Pain; Meperidine; Pregnancy

Topics: Analgesia, Obstetrical; Analgesics, Opioid; Female; Heroin; Humans; Labor Pain; Meperidine; Pregnancy

Topics: Analgesia, Obstetrical; Analgesics, Opioid; Female; Heroin; Humans; Labor Pain; Meperidine; Pregnancy

Topics: Female; Heroin; Humans; Labor Pain; Labor, Obstetric; Pregnancy; Rural Population; Scopolamine; Work