Risk Assessment of Using Entonox for the Relief of Labor Pain: A Healthcare Failure Modes and Effects Analysis Approach

A comparison of the effects of ENTONOX inhalation and spinal anesthesia on labor pain reduction and apgar score in vaginal delivery: a clinical trial study

INTRODUCTION

The purpose of the present study was to compare the effect of ENTONOX inhalation and spinal injection on the reduction of labor pain, the Apgar score of the neonates, and their side effects on new-born children and pregnant women.

MATERIAL AND METHODS

The present clinical trial study is conducted among the pregnant women in the maternity ward of a child delivery hospital in Iran. All Participants were divided in two groups ENTONOX Inhalation and Spinal Anesthesia. Visual Analogue Scale (VAS) was implemented to measure the pain level experienced by the participants during the procedure. Moreover, the Apgar scale was used to measure the general physical health of the neonates in both groups. In addition, the participants receiving ENTONOX were asked to report the side effects they underwent during gas inhalation. However, the participants in the spinal anesthesia were checked three times. Statistical analysis was performed using SPSS version 22.

RESULTS

The findings showed that the spinal anesthesia technique was significantly more effective than gas inhalation in that it reduced as much as 3 points more than did the inhalation (P-value: 0.001). Moreover, the comparison of the mean Apgar scores showed that the mean Apgar score of the neonates of spinal anesthesia mothers was 0.36 point lower than that of the neonates in the gas inhalation group. However, this difference was not statistically significant at P- value = 0.06.

CONCLUSIONS

the result of the present study indicated that spinal anesthesia was more effective than ENTONOX inhalation in reducing the labor pain.

Effect of Entonox for pain management in labor: A systematic review and meta-analysis of randomized controlled trials

Background and aim

Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor.

Methods

This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used.

Results

Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was −1.01 (95% CI: −1.59 to −0.43, Q=148.5, df=8, p=0.02, I²=76) this difference was significant (p<0.05). The overall Apgar score standard difference in mean between-groups (Entonox vs. comparison) was 0.12 (95% CI: 0.01 to 0.23, Q=109.4, df=16, p=0.00, I²=85.3) this difference was significant (p<0.05). The results of mothers’ satisfaction rate show that mothers in Entonox group has a high level of satisfaction rate.

Conclusion

According to results of studies published in Iran, it seems that Entonox is an effective method for pain relief in vaginal delivery, as well as for improving infant Apgar score and mothers’ satisfaction rate. Pain relief through Entonox can be used as a strategy for cesarean section reduction plan in Iran.

Environmental impact assessment of Gonabad municipal waste landfill site using Leopold Matrix

Introduction

An environmental impact assessment (EIA) before embarking on any project is a useful tool to reduce the potential effects of each project, including landfill, if possible. The main objective of this study was to assess the environmental impact of the current municipal solid waste disposal site of Gonabad by using the Iranian Leopold matrix method.

Methods

This cross-sectional study was conducted to assess the environmental impacts of a landfill site in Gonabad in 2015 by an Iranian matrix (modified Leopold matrix). This study was conducted based on field visits of the landfill, and collected information from various sources and analyzing and comparing between five available options, including the continuation of the current disposal practices, construction of new sanitary landfills, recycling plans, composting, and incineration plants was examined. The best option was proposed to replace the existing landfill.

Results

The current approach has a score of 2.35, the construction of new sanitary landfill has a score of 1.59, a score of 1.57 for the compost plant, and recycling and incineration plant, respectively, have scores of 1.68 and 2.3.

Conclusion

Results showed that continuation of the current method of disposal, due to severe environmental damage and health problems, is rejected. A compost plant with the lowest negative score is the best option for the waste disposal site of Gonabad City and has priority over the other four options.

Effect of Entonox on reducing the need for Pethidine and the Relevant Fetal and Maternal Complications for Painless Labor

Background

Pain relief during labour is one of the major concerns in obstetrics; severe labor pain causes fear of the next pregnancy, and interferes with the mother’s family relationship.

Objective

The aim of this study was to evaluate the analgesic effects of Entonox during labor on reducing the need for pethidine (Meperidine) and fetal-maternal complications.

Methods

This double-blind randomized clinical trial was conducted on pregnant women who were candidates for vaginal delivery in Educational Hospitals of Mashhad University of Medical Sciences, Iran between January 2014 and November 2015. After entering into the inactive phase of labor, participants were randomly allocated to receive inhaled Entonox gas (n=200) or inhale Oxygen (n=200) as a control group. Mothers inhaled the gas at commencement of pain, and ceased as soon as the pain diminished, up to the end of the second stage of labor which was the neonate’s birth. Main outcomes were pain score based on NRS (numerical rating scale), duration of delivery, required pethidine, maternal complications and satisfaction during labour. Chi-square and Independent T-test were used via SPSS for data analysis and P-value less than 0.05 was considered statistically significant.

Results

Four-hundred pregnant women with a mean age of 26.4±5.9 years were studied. Complications such as nausea, vomiting, dizziness, and drowsiness were reported in 25% of the Entonox group and 23% in the control group (p=0.640). Mean of pain severity score during labor in the Entonox and control groups was 4.5±1.2 and 5.2±1.4, respectively (p<0.001). Pethidine requirement, significantly was lower in the Entonox group (31.6±11.8 versus 35.7±12.4; p<0.001).

Conclusion

In our study, Entonox significantly reduced pain during delivery without significant increase in maternal and neonatal complications.

Trial registration

The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2015102713159N6.

Funding

This research has been financially supported by Research Council of Mashhad University of Medical Sciences.