Comparison of pentazocine and pethidine in normal labor. Analgesia during labor: a comparison of pentobarbital, meperidine, and morphine. A comparison of the effects of maternally administered meptazinol and pethidine on neonatal acid-base status. A double blinded randomised placebo-controlled study of intramuscular pethidine for pain relief in the first stage of labour. Preliminary clinical and pharmacokinetic experiences in the newborn when meptazinol is compared with pethidine as an obstetric analgesic. A comparison of the effects of pentazocine and pethidine administered during labour. Randomized comparison of meperidine and fentanyl during labor. Comparison of the effects of meperidine and nalbuphine on intrapartum fetal heart rate tracings. [Evaluation of the peripartum effects of 2 analgesics: meperidine and tramadol, used in labor]. Pethidine versus tramadol for pain relief during labor. Nalbuphine for obstetric analgesia. A comparison of nalbuphine with pethidine for pain relief in labour when administered by patient-controlled analgesia (PCA). A double-blind comparison of butorphanol and meperidine in labour: maternal pain relief and effect on the newborn. Double-blind comparison of maternal analgesia and neonatal neurobehaviour following intravenous butorphanol and meperidine. Pethidine compared with meptazinol during labour. A prospective randomised double-blind study in 1100 patients. EVALUATION OF PHENAZOCINE WITH MEPERIDINE AS AN ANALGESIC AGENT DURING LABOR, BY THE DOUBLE BLIND METHOD. [Pethidine and pentazocine. A double-blind investigation in obstetric material]. A comparison of meptazinol and pethidine for pain relief during the first stage of labour. Double-blind comparison of intravenous butorphanol (Stadol) and fentanyl (Sublimaze) for analgesia during labor. A comparison of patient-controlled analgesia fentanyl and alfentanil for labour analgesia. A comparison between pethidine and phenazocine (Narphen) for relief of pain in labour. Ventilatory depression of the newborn of women receiving pethidine or pentazocine. A double-blind comparative trial. Double-blind comparison of meptazinol and pethidine in labour. Comparative study of meptazinol and pethidine for the relief of pain in labour. Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine. A comparison of pethidine and remifentanil patient-controlled analgesia in labour. [Avacan versus Fortral. A controlled double blind investigation on parturient patients]. Effect of some recent analgesics on labor pain and maternal and fetal blood gases and pH. [Effectiveness and tolerance of tramadol with or without an antiemetic and pethidine in obstetric analgesia]. Meperidine hydrochloride and alphaprodine hydrochloride as obstetric Analgesic agents; a double-blind study. Patient controlled analgesia for labour: a comparison of remifentanil with pethidine. [Obstetrical analgesia with tramadol]. [Obstetrical analgesia with tramadol--results of a prospective randomized comparative study with pethidine]. A comparison of tramadol and pethidine analgesia on the duration of labour: a randomised clinical trial. Analgesia during labour: a comparison between dihydrocodeine and pethidine. Self-administered intravenous analgesia during labour. A comparison between pentazocine and pethidine. A double-blind comparison of intramuscular pethidine and nalbuphine in labour. Intravenous butorphanol, meperidine, and their combination relieve pain and distress in women in labor. Comparison of pentazocine and pethidine in labour. [Pain relief in childbirth; an analysis of the analgesic effects of transcutaneous nerve stimulation (TNS), pethidine and placebos (author's transl)]. A comparison of the analgesics pentazocine and pethilorfan in the relief of pain during labour. Double-blind comparison of intravenously injected butorphanol and meperidine in parturients. A randomized, placebo-controlled trial of the effects of pethidine on labor pain, uterine contractions and infant Apgar score. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. [Pethidine or nalbuphine for obstetric analgesia?].
nan nan A randomized double-blind study compared the effects of equi-analgesic doses of maternally administered meptazinol (1.5 mg/kg) and pethidine (1.5 mg/kg) on neonatal acid-base status. Heel-prick samples were taken for assessment of acid-base status at 10 and 60 min after delivery. Maternal antenatal history, details of labour and neonatal status at delivery were also recorded. Meptazinol produced less neonatal respiratory depression than pethidine: the mean 10 min acid-base data from 16 infants whose mothers received pethidine were indicative of a respiratory acidosis (pH 7.13, SD 0.08, PCO2, 9.11, SD 2.2 kPa; standard bicarbonate 22.3, SD 3.1 mmol/l). This was not evident in the mean acid-base data from 16 infants whose mothers received meptazinol (pH 7.23, SD 0.07; PCO2 6.83, SD 1.6 kPa; standard bicarbonate 20.9, SD 4.2 mmol/l). The mean pH and PCO2 in the two treatment groups were significantly different (P less than 0.002) at 10 min but not at 60 min after delivery. It has recently been suggested that systemic pethidine is ineffective in relieving labour pain. This study aims to evaluate the analgesic efficacy of pethidine in labour.
                This is a double blinded randomised placebo-controlled study.
                Labour suite, Prince of Wales Hospital, Hong Kong. Population Fifty normal Chinese pregnant women in early labour.
                We planned to randomise 112 women in early labour to receive either intramuscular pethidine 100 mg or normal saline when they requested analgesia. An interim analysis was performed at sample size 50.
                The primary outcome assessed was the visual analogue scale (VAS) pain score after 30 minutes.
                The study was terminated after recruitment of the first 50 women when planned interim analysis showed a significantly greater reduction of VAS pain score in the pethidine group (P= 0.009). The median difference in VAS pain score between the two groups at 30 minutes was -17 [95% CI -30 to -4]. Mean time to first subsequent request for analgesia was greater in the pethidine group (232 minutes, 95% CI 135 to 329 minutes) compared with the control group (75 minutes, 95% CI 54 to 95 minutes). Eight women (32%) in the pethidine group needed no further analgesia vs one woman (4%) in the control group (P= 0.011). Women in the pethidine group gave greater scores for sedation and satisfaction. Neonatal outcome was similar.
                Systemic pethidine was more effective at relieving labour pain than placebo. Its analgesic effect, however, was modest. Preliminary results on the disposition of meptazinol in the neonate are reviewed. Meptazinol has a half-life of 3.4 hours compared with 22.7 hours for pethidine. In a randomised double blind trial of 100 patients the depressant effects in the newborn of meptazinol and pethidine were compared. There was no difference in the Apgar scores at 1 and 3 minutes. Weight loss and the incidence of neonatal jaundice were less when mothers received meptazinol although these differences did not reach statistical significance. However, the number of infants considered fit for discharge by the 6th day was significantly greater in the meptazinol groups. In 43 cases transcutaneous monitoring of arterial PO2 was carried out for 30 minutes following delivery. Although the mean PaO2 was similar for meptazinol and pethidine, significant variations in the PaO2 of 2.0 kPa or greater and significant neonatal activity as judged by episodes of crying and movement, were recorded in the meptazinol group. The results of the trial suggest that meptazinol may have less depressant effects on the newborn, and may be preferable to pethidine as an obstetric analgesic. nan This randomized investigation compared the efficacy of the conventional narcotic, meperidine, and a more potent and short-acting analgesic, fentanyl, during labor. One hundred five women with uncomplicated term pregnancies in active labor were randomly assigned to receive either intravenous fentanyl (50-100 micrograms every hour) or meperidine (25-50 mg every 2-3 hours) in a non-blinded manner. The analgesics were rated equivalent in efficacy. Maternal nausea, vomiting, and prolonged sedation occurred more frequently in the meperidine group. Naloxone use was significantly less in fentanyl- than in meperidine-exposed infants (one of 49 versus seven of 56; P less than .05). Neuroadaptive testing at approximately 2 hours and 24 hours postnatally revealed similar averaged scores in the two groups. Using the described intravenous dosing schedule, fentanyl was preferable to meperidine during labor because there was no prolonged maternal sedation or vomiting necessitating therapy and the requirement for neonatal naloxone was reduced. To examine the effects of meperidine and nalbuphine on intrapartum fetal heart rate (FHR) tracings using computer analysis.
                We studied 28 women with uncomplicated pregnancies in early labor at term with reactive FHR tracings. The women were randomized to receive either meperidine 50 mg or nalbuphine 10 mg intravenously on request. One-hour FHR recordings were obtained before and immediately after administration of the medications.
                There were no significant differences in the FHR characteristics of the two groups during the pre-treatment period. Nalbuphine significantly decreased the number of accelerations of 10 beats per minute (17 versus 4, P = .003) and 15 beats per minute (10 versus 1.5, P = .001), time spent in episodes of high variation (35.5 versus 10 minutes, P = .004), long-term variation (47 versus 29.8 milliseconds, P = .002), and short-term variation (8.4 versus 6.4 milliseconds, P = .03). Meperidine had no significant effect on any FHR characteristic.
                In the early intrapartum period of normal term pregnancies and at commonly used dosages, nalbuphine had a significant effect on FHR tracings, whereas meperidine had no effect, as determined by computer analysis. The need for analgesia to overcome pain in labour is highly requested by women today. Various ways either non pharmachologic e.g. Emotional sustain, psycho-prophylactic preparation, yoga and hypnosis or pharmachologic such as epidural blockade or parenteral are used. Therefore in our study we evaluated the efficacy and tolerability of the two opioids usually used today in parenteral analgesia to reduce pain during labour: Tramadol and Meperidine. We studied two groups of patients each made up of 20 women in labour, all at term and with a physiologic course of pregnancy. 75 mg i.m. of Meperidine chloryhydrate were somministered in the first group while in the second group 100 mg i.m. of tramadol chloryhydrate were somministered. Various maternal, fetal and neonatal parameters were then monitored demonstrating--A moderate maternal analgesic effect in both drugs (evaluated through the analogic grading of pain). In the group to whom Meperidine was given, sedative effects on the mother were observed associated with respiratory depression in the newborn (the latter evaluated through the Apgar index at 1st and 5th minute of life and pH of the blood obtained at the umbilical cord. The data obtained permitted us to conclude that Tramadol in accordance to the obtained in literature gives an analogous analgesic effect, with better tolerability for the absence of collateral effects on the mother, fetus and newborn. To evaluate and compare the analgesic efficacy and adverse effects of tramadol and pethidine in labor.
                Fifty-nine full term parturients were randomly assigned to one of two groups in active labor. Group 1 received 100 mg pethidine; group 2, 100 mg tramadol, intramuscularly. Analgesic efficacy, maternal side effects, changes in the blood pressure, heart rate, and duration of labor were assessed.
                At 30 and 60 min after drug administration, pain relief was greater in the pethidine group than in tramadol group. The incidence of nausea and fatigue was higher in the tramadol group. Following drug administration the decrease in systolic and diastolic blood pressure and the increase in heart rate were statistically significant in both groups. No significant difference was found between the groups when compared for duration of labor and Apgar scores. None of the neonates developed respiratory depression.
                Pethidine seems to be a better alternative than tramadol in obstetric analgesia because of its superiority in analgesic efficacy and low incidence of maternal side effects. A double-blind, randomised study of 60 patients who received intravenous increments of nalbuphine 3 mg or pethidine 15 mg by patient-controlled analgesia during the first stage of labour, was carried out. Pain intensity, sedation, uterine contractions, maternal cardioventilatory variables and fetal heart rate were recorded as well as any side effects. Apgar scores, time to sustained respiration and resuscitative measures required for the neonate were noted at delivery. Modified neonatal neurobehavioural studies and a retrospective assessment of maternal analgesia, satisfaction and tolerance were also carried out. Group mean values of pain scores of nalbuphine-medicated primiparous women were statistically significantly lower than those of pethidine-medicated patients (p less than 0.01). Other assessments did not demonstrate a statistical significance between the two groups. Butorphanol tartrate 1 mg and 2 mg were compared in 80 normal mothers at term in a double-blind study with meperidine hydrochloride 40 mg and 80 mg for the relief of pain in labour. Butorphanol was found to be as effective as meperidine in relieving pain in labour. The foetal condition, as measured by ECG monitoring, Apgar scores, time to sustained respiration, umbilical venous H+ (pH) and PCO2, and a general nursery survey were comparable for meperidine and butorphanol. No psychomimetic phenomena were seen. Assays indicated that both butorphanol and meperidine crossed the placenta. The mean concentration of butorphanol in neonatal serum was 0.84 times maternal serum at 1.5 to 3.5 hours after intramuscular administration of a single or two successive doses of butorphanol 1 mg or 2 mg to the mother. The mean concentrations for meperidine in neonatal serum was 0.89 times maternal serum at 0.85 to 3.6 hours after intramuscular administration of meperidine 40 mg or 80 mg to the mother. Neither analgesic caused severe depression of the infant except for one meperidine-treated case. Butorphanol (1 mg and 2 mg) and meperidine (40 mg and 80 mg), given intravenously, were evaluated for analgesic efficacy and safety in a double-blind randomized study employing 200 consenting pre-partum patients in moderate to severe pain during the late first stage of labour. Both drugs provided adequate relief of pain to the mothers. There was no significant difference in the rate of cervical dilation, the foetal heart rate, the Apgar score, pain relief or neonatal neurobehavioural scores betweeen those receiving butorphanol and those receiving meperidine. Twenty-two mothers who received butorphanol and eleven who received meperidine nursed their infants with no adverse effects observed. Side-effects were generally infrequent in this study; however, more side-effects were reported by the patients and observed by the investigator in the meperidine-treated cases (13%) than in the cases treated with butorphanol (2%). A randomised double-blind comparison of pethidine and meptazinol used as analgesics in labour was carried out in 1,100 consecutive women who would normally have received intramuscular pethidine. Pain assessments at 30-minute intervals were made independently by patients and midwives. Maternal and neonatal side effects were noted. The babies' requirements for resuscitation and weight changes in the first 5 days were studied. There was no difference in the analgesia provided by the two drugs; the pattern of side effects was similar, but the incidence of vomiting was greater following meptazinol administration. The babies in the two groups were similar with respect to resuscitation received, weight gains or losses and the incidence of clinical neonatal jaundice. The most striking findings were the poor quality of pain relief experienced by both groups following parenteral analgesics and the high incidence of side effects. nan nan Meptazinol and pethidine were compared in a double-blind randomized trial with regard to analgesia during the first stage of labour. It was concluded that neither drug is effective for sustained pain relief, and that there is no advantage of one over the other. However, neither drug affected maternal condition as reflected by respiratory rate, pulse rate and blood pressure, nor was any detrimental effect noted on the condition of the newborn infant. The critical reassessment of traditional drugs for analgesia in labour is suggested. Our purpose was to compare the analgesic properties, effect on labor, and maternal-fetal side effects of intravenous butorphanol and fentanyl.
                One hundred patients with uncomplicated term pregnancies were enrolled during early active labor. Each patient received standard doses of either fentanyl (50 to 100 micrograms) or butorphanol (1 to 2 mg) hourly on request in a double-blind manner. Pain was scored independently by the nurse and patient with a 10-point visual analog scale. Categoric and measurement data were collected for comparison of the effects on uterine activity, maternal and fetal well-being, and neonatal outcomes.
                The fentanyl (n = 50) and butorphanol (n = 50) groups were identical with respect to maternal age, race, parity, and weight. Greater improvement in pain relief was found after the first dose of butorphanol than after fentanyl (p < 0.05). When fentanyl was given, either more doses were necessary (3.2 +/- 1.3 vs 2.1 +/- 1.1, p < 0.01) or epidural analgesia was requested more often (16%, 32% vs 9%, 18%, p < 0.05). Uterine contraction patterns for the first hour after dosing were unchanged, and the duration of the first and second stages of labor were not different between the two groups. No differences in maternal or newborn adverse effects were observed.
                Both drugs were equally safe and without effect on active labor. Butorphanol provided better initial analgesia than fentanyl with fewer patient requests for more medication or epidural analgesia. To determine the analgesic efficacy of equipotent doses of PCA (patient-controlled analgesia) fentanyl and PCA alfentanil for labour pain.
                Twenty three, ASA I - II parturients between 32-42 wk gestational age in whom epidural analgesia was contraindicated were randomized to receive PCA fentanyl (Group F)or alfentanil (Group A). Plain numbered vials contained 21 ml fentanyl 50 microg x ml(-1) or alfentanil 500 microg x ml(-1). A one millilitre loading dose was administered. The PCA solution was prepared by diluting 10 ml study drug with 40 ml saline and the PCA pump was programmed to deliver a dose of 2 ml, delay of five minutes and a basal rate of 2 ml x hr(-1). Maternal measurements obtained were hourly drug dose, total dose, Visual Analog Pain Score (VAPS) q 30 min, sedation score q 1 hr and side effects. Neonates were assessed by 1,5, and 10-min Apgar scores, umbilical venous and arterial blood gases and neurobehavioural scores at four and 24 hr.
                Mean VAPS from 7 - 10 cm cervical dilatation were higher in Group A than in Group F (85.7+/-13.9 vs. 64.6+/-12.1; P<0.01) There were no inter-group differences in VAPS from 1-3 cm, or from 4-6 cm dilatation, in maternal sedation scores or side effects, or in neonatal outcomes.
                In the doses prescribed in this study, PCA fentanyl was found to provide more effective analgesia in late first stage labour than PCA alfentanil. nan Forty-two women at term received pethidine 100 mg and 43 received pentazocine 45 mg, both given in a double-blind randomized manner. There was no difference in analgesic effect between the groups, but twelve patients were judged to need more than one injection of pentazocine, compared with seven in the pethidine group. The Apgar scores at 1 and 5 min were significantly less in the pethidine group. Four neonates in the pethidine group and two in the pentazocine group were severely depressed and received naloxone between 5 and 15 min after birth. The remainder of the infants received naloxone 200 microgram i.m. 15 min after birth. From 5 min after birth, end-expiratory carbon dioxide concentrations and from 15 min transcutaneous PO2 were recorded. A significantly smaller end-tidal carbon dioxide concentration was measured when more than one injection of pentazocine had been given. Repeated doses of pethidine, on the other hand, resulted in a greater end-tidal carbon dioxide concentration. Vigorous ventilation was even more pronounced when naloxone was given indicating an analeptic effect when two drugs with antagonistic activity are combined. At no time was transcutaneous PO2 less than 6.1 kPa. We conclude that both pethidine and pentazocine produce adequate pain relief during labour, but more than one injection of pethidine is associated with greater neonatal depression. The analgesic efficacy and safety of intramuscular meptazinol and pethidine in the first stage of labour were compared in a randomized double-blind trial in 358 patients. Pain relief was measured on a verbal rating scale, maternal side effects were recorded and neonatal outcome assessed in the first 24 h. Pain relief during the first hour after injection was significantly greater in the meptazinol than in the pethidine group at 45 and 60 min. Thereafter, there was no difference between the treatments, and the duration of action was approximately the same. Twenty-eight per cent of patients experienced side effects after meptazinol compared with 35% after pethidine. The commonest were nausea and vomiting with a similar incidence in both groups. Most of the neonatal observations revealed no difference between the two drugs, but significantly more babies whose mothers had received meptazinol had an Apgar score of greater than or equal to 8 at 1 min after birth. A double-blind comparison of pethidine and meptazinol in the relief of pain during labour was undertaken in 205 healthy women. The protocol allowed 100 mg of the test drug to be repeated at intervals of 2 h to a maximum of three doses. It was noteworthy that only 29 mothers were given a second dose of narcotic. Every woman receiving one injection of meptazinol complained of moderate to severe pain after 2 h; 97% of those receiving one injection of pethidine were complaining of moderate to severe pain after 2 h. There was no difference between the two drugs with regard to pain relief or in side-effects both in mother and baby. To compare the pain relief and side effects of intramuscular pethidine with intramuscular diamorphine in labour.
                Double-blind randomised controlled trial.
                The labour ward in a UK teaching hospital.
                Sixty-nine nulliparous women and 64 multiparous women in labour who requested narcotic analgesia and remained undelivered one hour after trial entry.
                Nulliparous women were randomised to receive either 150 mg intramuscular pethidine or 7.5 mg intramuscular diamorphine. Multiparous women were randomised to receive either 100 mg intramuscular pethidine or 5 mg intramuscular diamorphine. All participants received the anti-emetic prochloroperazine at the same time as the trial drugs.
                Maternal analgesia assessed by a visual analogue score and verbal scales of pain intensity and pain relief, maternal sedation and vomiting, neonatal outcome assessed by Apgar scores and the need for resuscitation.
                More women allocated to receiving pethidine than to diamorphine reported slight or no pain relief at 60 minutes after administration of these drugs (P = 0.03). This trend was repeated in most of the other measures for maternal analgesia. There was no difference in maternal sedation, but the incidence of vomiting within 60 minutes was lower for women who received diamorphine (P = 0.02). Pethidine was associated with lower Apgar scores at 1 minute (P < 0.05).
                Intramuscular diamorphine in labour appears to have some benefits, compared with intramuscular pethidine, but the trial was small and further research, particularly into alternative opioids and long term effects on the infants is still needed. We conducted a double-blind randomised controlled trial comparing the efficacy of analgesia during labour of remifentanil and pethidine. Nine women were randomised to receive an i.v. bolus of remifentanil 0.5 microg.kg(-1)with a lockout period of 2 min and eight women were randomised to receive a bolus of pethidine 10 mg with a lockout period of 5 min. A visual analogue scale (VAS) scoring system was used to assess the level of pain hourly throughout the first and second stages of labour and a score was recorded within half an hour of delivery for the level of pain overall throughout labour (post delivery score). The study was terminated after 17 subjects, on agreement with the local ethics committee, due to concern with the poor Apgar scores in the pethidine group. With the data available, we demonstrated significantly lower mean hourly and post delivery VAS scores for pain in the remifentanil group (P < 0.05). The 1 and 5 min Apgar scores were significantly lower in the pethidine group compared with the remifentanil group (P < 0.05). This preliminary study suggests that remifentanil may have a use as patient-controlled analgesia for women in labour. nan This study attempts to determine the analgesic properties of nalbuphine, pentazocine and butorphanol during labor and their potential effects on maternal and fetal blood gases and pH. Butorphanol analgesia was superior to either nalbuphine or pentazocine in relieving labor pain. The studied analgesics caused significant maternal respiratory acidosis and fetal metabolic acidosis. These acidotic changes were most marked with pentazocine, moderate with nalbuphine and minimal with butorphanol. The aim of this prospective, randomised, blind study was to investigate the analgesic potency and tolerance of intramuscular Tramadol compared to a standard obstetric analgesia with Pethidine. Triflupromazine was administrated in combination with the two tested analgesics in order to study its efficacy in alleviating the emetic side effects of the tested analgesics. 66 parturients were randomly assigned to three groups: group A: 100 mg Tramadol (Tramal), group B: 100 mg Tramadol (Tramal) and 10 mg Triflupromazine (Psyquil), group C: 50 mg Pethidine (Alodan) and 10 mg Triflupromazine (Psyquil). No significant differences concerning duration of labour, FHR-alterations, umbilical cord blood gases, respiration pattern and Apgar Scores of the neonate occurred. In all three groups the analgesic effect was equally good. Combination of the analgesic with the antiemetic showed no reduction of the incidence and severity of side effects. nan We compared the analgesic efficacy and safety of remifentanil and pethidine via patient controlled analgesia for women in established uncomplicated labour. Women received either remifentanil 40 microg with a 2-min lockout (n = 20) or pethidine 15 mg with a 10-min lockout (n = 19). Visual analogue scores for pain during the study and for overall pain were similar for both groups (mean (SD) 6.4 (1.5) cm for remifentanil and 6.9 (1.7) cm for pethidine). The area under the curve for visual analogue scores of satisfaction with analgesia was higher for remifentanil than for pethidine (p = 0.001). Maternal arterial oxygen saturation was similar in both groups. Neurologic and Adaptive Capacity Scores at 30 min were higher for remifentanil than for pethidine (median (interquartile range [range]) 36 (34.5-37 [32-39]) vs 34 (33-35 [30-35]), respectively; p = 0.003). Parenteral analgesia with Tramal was performed in 23 normal deliveries. The results were compared with a group of normal deliveries in which analgesia was achieved with pethidine. Both medicaments excerted an identical analgetic efficiency. No adverse side effects were observed with Tramal concerning the follow-up of labour or the newborn. Tramal can be recommended for obstetrical analgesia since it does not excert inhibitory effects upon the respiratory center. Morphine derivatives are the most frequently used analgetic substances in obstetrics today. Nevertheless, nausea, vomiting, weariness, and somnolence are common side effects of these drugs. Moreover opiates exhibit a depressive effect on ventilatory activity. As many studies have demonstrated tramadol, a new analgetic substance amongst the opiates does not show a depressive effect to such a high degree. In this prospective randomized trial we compared the efficacy as well as the safety of 100 mg tramadol and 100 mg pethidine in 40 women asking for pain relief during labour. The duration of labour was slightly but not statistical significantly shorter in the pethidine group. An analgetic effect could be observed in the pethidine as well as the tramadol group by both the pregnant women and the attending physician about 10 min after application lasting for about 2 hours. Concerning the side effects tramadol highly contrasted with pethidine. There were less cases of weariness and somnolence and the ventilatory frequency of the newborn babies tended to be higher than in the pethidine group. The serum levels of tramadol in umbilical and maternal veins demonstrated values of 0.83 +/- 0.15 (mean +/- SEM; quotient). The results of this study seem to establish an analgetic effect of tramadol similar to pethidine but with less side effects. The ideal obstetric analgesia should provide analgesic efficacy without attenuation of uterine contractions.
                To compare the outcome of intramuscular administration of pethidine and tramadol in labour analgesia.
                One hundred and sixty full-term parturients were randomly assigned to two equal groups in active labour. Group P received 50 mg pethidine; and group T, 100 mg tramadol intramuscularly. Primary outcome measure was the duration of the labour. The analgesic efficacy, maternal side-effects, mode of delivery, maternal satisfaction and Apgar score as the secondary outcome were assessed.
                The duration of labour was shorter in group T, for first stage (190 vs 140 min; P < 0.0001) and for second stage (33 vs 25 min; P = 0.001). There were no differences in Groups P and T with respect to median (7 vs 8) and maximum (7.5 vs 8) visual analog scores (VAS) for pain at 10 min and one hour after drug administration. Women in group P had lower VAS pain scores than those in group T in the second stage of labour (8 vs 9; P = 0/009). There was a significantly higher incidence of nausea and vomiting (35% vs 15%; P = 0.003) and drowsiness (80% vs 29%; P < 0.0001) in group P.
                Both 100 mg tramadol and 50 mg pethidine provide moderate analgesia in first stage of labour. Tramadol seems to cause a shorter duration of labour and lower incidence of maternal side-effects. However, its analgesic efficacy was not found to be as effective as pethidine, especially in the second stage of labour. nan Pentazocine or pethidine was administered to healthy parturients up to the time of delivery using a self-demand (self-administration on demand) intravenous apparatus, the Cardiff Palliator. Good analgesia was obtained with both drugs. The patients receiving pethidine exhibited side-effects (nausea, vomiting and drowsiness), whereas there were no side-effects among those receiving pentazocine. Apgar and neurobehavioural scores of the babies of mothers in both groups were the same and did not differ from those of a third group of babies, the mothers of whom had received 4-hourly intramuscular pethidine on demand according to the usual hospital routine. The self-administration technique proved a safe and effective means of providing analgesia during labour and delivery, with pentazocine having a decided advantage over pethidine because of its lack of side-effects. A double-blind, between-patient comparison of intramuscular pethidine 100 mg and nalbuphine 20 mg for the relief of pain during labour in 80 patients is described. Severity of pain was assessed before and after treatment by subjective pain scores and visual analogue scales. Neither of these methods showed a significant difference between the treatments. Nalbuphine was associated with less maternal nausea and vomiting than pethidine, but this possible advantage was somewhat offset by a tendency of the drug to produce more maternal sedation and dizziness. The mean umbilical vein/maternal vein ratio was significantly higher for nalbuphine (0.78, SEM 0.03) than for pethidine (0.61, SEM 0.02), which suggests easier placental transfer of the former. This finding was reflected in significantly lower 2-4 hour neurobehavioural scores for the infants of mothers given nalbuphine, but there was no significant difference between these scores at 24 hours. On the basis of this study, nalbuphine does not offer a substantial improvement over pethidine for pain relief in labour. Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong rationale for combining mu- and kappa-opioid receptor agonists for analgesia. The authors therefore studied, using validated intensity and affective scales and definitions of effective pain relief, the efficacy of intravenous meperidine, butorphanol, and their combination for labor analgesia.
                Healthy women with singleton term pregnancy requesting analgesia during active labor were studied. Women were randomly assigned to receive 50 mg meperidine, 1 mg butorphanol, or 25 mg meperidine plus 0.5 mg butorphanol (n = 15/group). Pain intensity was assessed using a 0-10 numerical rating scale, and affective magnitude was assessed using a ratiometric descriptive scale before drug administration and between the sixth and seventh uterine contractions after drug administration.
                All three treatments reduced pain intensity equally. Butorphanol alone did not reduce pain affective magnitude, whereas the other treatments did. There was a significant correlation between reduction in pain intensity and affective magnitude in all groups, with greater reductions in affective magnitude than intensity. Overall, 29% of women exhibited clinically meaningful pain relief, with no difference among groups. Groups did not differ in incidence of opioid-induced adverse effects.
                These doses of meperidine and butorphanol do reduce pain intensity and affective magnitude, although a minority of patients achieve meaningful pain relief as defined in multiple patient populations, including laboring women. Combination of these drugs did not improve their therapeutic benefit. A double-blind between-patient study was carried out comparing pentazocine with pethidine in 94 women in labour. Similar analgesic and sedative effects were obtained with the two drugs, and Apgar scores were similar for babies of both drug groups. Fewer emetic sequelae were reported after pentazocine injections, though there was no statistically significant difference between the two drug groups in incidence of other side-effects. The analgesic affects of TNS, pethidine and placebos on labour pain were studied in 30 parturient women during the first stage of labour. 10 had TNS paravertebrally in the region of the afferent nerves at Th 10-Th 12; one group of 5 had unspecific (wrong) TNS; in another group of five no current was applied (placebo); five women were given 50 mg of pethidine intravenously; five patients acted as a control group. To assess the analgesic effects the women were asked to estimate the intensity of pain (grades 1-6) over a period of 70 minutes. There was no significant difference between the placebo, unspecific TNS and control groups as regarded the increase in pain during the test period. Patients who had received pethidine and those who had been given TNS at the site of the afferent nerves transmitting impulses from the uterus experienced considerable relief of pain. The differences were highly significant. The observations prove the genuine analgesic action of TNS. The use of this technique in obstetrics is discussed. nan One hundred women with moderate-to-very-severe prepartum pain participated in a double-blind study of intravenously injected butorphanol and meperidine that compared the analgesic properties, effect on the process of labor, condition of the newborn and the incidence of side effects associated with the two drugs. Cervical dilation, infant birth weight and Apgar scores were not significantly different between the test groups. The mean fetal heart rate for the butorphanol group was significantly faster than that of the meperidine group. Butorphanol provided significantly more analgesia than meperidine at 30 minutes and one hour after administration, based on pain intensity and pain relief scores. Some side effects, including sedation, dizziness, lightheadedness, nausea, vomiting and pain at the injection site, were reported for both drugs. nan To compare the analgesic efficacy of remifentanil with meperidine and fentanyl in a patient-controlled setting (patient-controlled analgesia, PCA).
                Parturients (n=159) were randomly assigned to receive remifentanil (n=52), meperidine (n=53), or fentanyl (n=54). Pain scores and an observer sedation scores were assessed hourly. Fetal outcome was evaluated with Apgar score, cord blood gas analysis and the Neurologic and Adaptive Capacity Score.
                Pain scores decreased in all groups, the decrease varying from mild to moderate, average pain scores remaining above 4.5 cm in all groups. Remifentanil PCA was associated with the greatest decrease in pain scores, but the difference was significant only at 1 h. Pain scores returned towards baseline over time; 3 h after the initiation of treatment, pain scores no longer differed significantly from baseline values in any of the groups. Significantly more parturients receiving meperidine crossed over to epidural analgesia. Overall satisfaction scores were higher with remifentanil, but remifentanil produced more sedation and itching. More periods of desaturation (Sa(o(2)) <95%) were observed during administration of remifentanil and fentanyl. There were no significant differences in fetal outcome between the three groups.
                The efficacy of meperidine, fentanyl, and remifentanil PCA for labour analgesia varied from mild to moderate. Remifentanil PCA provided better analgesia than meperidine and fentanyl PCA, but only during the first hour of treatment. In all groups, pain scores returned to pre-treatment values within 3 h after the initiation of treatment. Because of the risk of ventilatory depression, agonistic and partially agonistic/antagonistic opiates are well suited for providing pain relief in obstetrics. We compared two groups of 20 women each with pregnancy on term who received equipotent doses of nalbuphin (0.1 mg/kg) and pethidin (0.8 mg/kg) intramuscularly. We found a significantly longer (6h) and better analgesic effect in the nalbuphin group but also a significantly more pronounced sedation. Other side effects were fewer in this last-named group. There were no differences in the behaviour of the babies between both groups. We consider that because of the "ceiling effect" of ventilatory depression, nalbuphin may allow better analgesia without the risk of ventilatory depression of both mother and newborn.
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. This review needs to be examined alongside related Cochrane reviews examining pain management in labour. More research is needed to determine which analgesic intervention is most effective, and provides greatest satisfaction to women with acceptable adverse effects for mothers and their newborn.