Pethidine Versus Nitrous Oxide for Pain Relief During Labor
Condition: Labor Pain
MeSH terms: Labor Pain
Study type: Interventional

Summary: 
      Systematic opioids and inhaled nitrous oxide (N2O ) are common methods for pain relief during
      labor. The aim of the current study is to evaluate the efficacy of systemic pethidine
      compared to N2O given for pain relieve in term, multiparous women in labor.
    

Detailed description: 
      Pain relief during labor and delivery is an essential part of good obstetrical care. Labor
      pain and its relief have implications on the course of labor, maternal and fetal outcomes and
      the satisfaction with childbirth overall. Many women would like to have a choice in pain
      relief during labor but also would like to avoid invasive methods of pain management in labor
      (as epidural). Both, inhaled analgesia and parenteral opioids are common pharmacological
      interventions aim to relieve the pain of labor.Nitrous oxide in a 50/50 mix with oxygen is
      the most common concentration used for labor pain management. It is self-administered via
      facemask, intermittently, and has rapid onset and offset effect. Main side effects, including
      nausea, vomiting, dizziness and drowsiness. Pethidine is one of the most frequently used
      opiate agonists. It can be given intravenous or intramuscularly. Its analgesic effect starts
      within 10-20 minutes and lasts 2-4 hours. Reported maternal side effects include nausea,
      vomiting and dysphoria. Pethidine may lead to changes in fetal heart rate tracing during
      labor, respiratory depression, impaired sucking reflex and restlessness.

      Given the fact that these two routine interventions are given in different ways and have
      different side effects profile, the investigators aim in this randomized controlled trial to
      compare the analgesic effect of these two methods and their maternal and perinatal secondary
      effects in multiparous laboring women.
    

Intervention name(s): IV Meperidine; Nitrous Oxide
Intervention type(s): Drug; Drug
Intervention description(s): Intravenous meperidine 50mg in 100cc NaCl 0.9% . Repeated doses (if needed): intervals of 2 hours minimum until a maximum of 4 doses.
In cases of nausea or vomiting intravenous metoclopramide 10mg will be offered to the parturient.
If pain intensity (according to visual analogue scale), 20 to 30 minutes from administration, will not decline or the parturient will ask for a different type of analgesia, inhaled nitrous oxide or epidural analgesia will be offered.; Nitrous oxide in a 50/50 mix with oxygen given via self-administered face mask. The parturient will be advised to place the mask tightly on her face and to breathe through it at the first sign of forthcoming uterine contraction. Between contractions, she will be advised not to breathe through the mask.
In cases of nausea or vomiting intravenous metoclopramide 10mg will be offered to the parturient.
If pain intensity (according to visual analogue scale), 20 to 30 minutes from administration, will not decline or the parturient will ask for a different type of analgesia, intravenous meperidine or epidural analgesia will be offered.
Other intervention name(s): Pethidine; N2O
Intervention MeSH terms: Meperidine; Nitrous Oxide
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Labor analgesia; Nitrous Oxide; Meperidine; Multiparous; Visual analogue scale