Schmerztherapie in der Geburtshilfe

SPAM-sub partual analgesia with meptazinol: a prospective cohort study comparing intramuscular with intravenous administration

PURPOSE

Safe and effective analgesia sub partu is one of the central issues in optimizing vaginal delivery birth experiences. Meptazinol is a common opiate approved for treating labor pain in the first stage of labor. According to the manufacturer, manual meptazinol can be applied intramuscularly or intravenously. The aim of this study was to compare the two application methods in terms of efficacy in pain relief, occurrence of side effects and treatment satisfaction.

METHODS

132 patients with singleton term pregnancies and intended vaginal delivery, receiving meptazinol during first stage of labor were included in this prospective cohort study from 05/2020 to 01/2021. We evaluated effectiveness in pain relief and treatment satisfaction using numeric rating scales (NRS) and documented the occurrence of adverse effects. Chi-square test or Fisher exact test were used to compare categorical data and Mann-Whitney U test to compare continuous data between the two treatment groups. Statistical analysis was done by SPSS 27.0. A p value < 0.05 was considered to indicate statistical significance (two tailed).

RESULTS

Meptazinol decreased labor pain significantly from a NRS of 8 (IQR 8-10) to 6 (IQR 4.75-8) in both treatment groups with no difference in effectiveness between the groups. Frequency of effective pain reduction of a decrease of 2 or more on the NRS did not differ between groups (39.4% vs 54.5%, p = 0.116), as the occurrence of adverse effects. 12% of the newborns were admitted to NICU, the median NApH was 7.195.

CONCLUSION

Meptazinol significantly reduces labor pain regardless of the method of application: intramuscular or intravenous. According to our data, no preferable route could be identified. The comparably poorer perinatal outcome in our study cohort hinders us to confirm that meptazinol is safe and can be recommended without restrictions.

Obstetric analgesia utilization in labor pain management and associated factors among obstetric care providers in the West Shewa Zone, Central Ethiopia

Objectives:

Labor pain is the worst pain that almost every woman experiences during childbirth. Labor pain management plays a crucial role in promoting maternal-wellbeing, contributing enormously to maternal satisfaction with the childbirth experience and the high quality of services. Although there have been previous studies, they have primarily been conducted at referral or general hospitals located in urban settings. Thus, this study aimed to assess the utilization of labor pain analgesia and associated factors among obstetric care providers at all levels of health facilities in central Ethiopia.

Methods:

A multicenter institution-based cross-sectional study design was employed from 1 July to 30 September 2020. Simple random sampling using the lottery method was employed to select 399 obstetric care providers. The data were entered into Epi-data version 4.2 and analyzed using SPSS version 26. Bivariate and multivariable logistic regression analysis were used to identify the associated factors. The adjusted odds ratio with its 95% confidence interval and p value ⩽ 0.05 were used to identify associated factors.

Results:

The overall utilization of obstetric analgesia was 46% (95% confidence interval: 41.2%–50.8%). Being a Midwife (adjusted odds ratio: 2.10, 95% confidence interval: 1.27–3.47), having heard of the World Health Organization pain ladder (adjusted odds ratio: 2.95, 95% confidence interval: 1.73–5.01), having favorable attitude (adjusted odds ratio: 1.89, 95% confidence interval: 1.17–3.05), the expectation of obstetric care providers about labor pain (adjusted odds ratio: 3.26, 95% confidence interval: 1.27–8.36), having training on labor pain management (adjusted odds ratio: 2.51, 95% confidence interval: 1.03–6.07), and presence of chance for preference of obstetric analgesia for mothers in the facility (adjusted odds ratio = 2.30, 95% confidence interval: 1.33–3.98) were identified as factors significantly associated with the practice of obstetric analgesia among obstetric care providers.

Conclusion:

The overall use of labor pain management methods among obstetric care providers is low. Professional category, provider attitude, labor pain severity expectations, and having training were found to be factors associated with the use of obstetric analgesia. Therefore, working on adapting and disseminating the harmonized guideline and protocols on labor pain management and provision of training for obstetric care providers on labor pain management techniques were recommended.

[Effects of Obstetric Analgesia with Systemic Opioids on the Newborn - A Review]

INTRODUCTION

Three-quarters of all women receive analgesia during labor. There are regional and systemic analgesia procedures available. In this review, we investigate the impact of obstetric analgesia using systemic opioids on neonatal outcomes.

METHODS

We searched the PubMed and Cochrane Library databases using the following search terms: "meptazinol", "meptide", "analgesia", "painkiller", "pain reliever", "obstetrics", "labor", "labour", "delivery", "neonate", "newborn", "child", "baby", "infant", "fetus", "fetal", "opioid" and "opiate" as well as performed an additional MeSH Terms search in PubMed.

RESULTS

Of 355 potentially relevant studies, we included 23 studies in this review. The studies varied widely in quality, sample size, and outcome criteria. Neonatal outcome was often only a secondary endpoint. Rarely were significant differences related to neonatal outcome reported between the different systemic opioids or compared with control groups. Twelve studies compared neonatal APGAR scores between treatment groups, with ten (83%) of these studies showing no differences.

DISCUSSION/OUTLOOK

In summary, we assess the evidence as limited and ambiguous as to whether systemic obstetric opioid therapy negatively affects the newborn. Studies regarding the long-term outcome of the newborns are lacking. A statement regarding the necessity of postnatal monitoring of newborns after maternal obstetric opioid therapy cannot be concluded. Further studies, ideally with a prospective study design and control group, should be considered.