Cochrane · systematic review · CD007396
Parenteral opioids for maternal pain management in labour
Smith, LA, Burns, E, Cuthbert, A · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
56
current version
GRADE rated
54
No studies
2
Included studies
NR
No studies 2 · 3.6%Ungraded 0 · 0%Very low 30 · 53.6%Low 20 · 35.7%Moderate 1 · 1.8%High 3 · 5.4%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
IM pethidine compared to placebo for pain management in labour
Population: women in labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal satisfaction with analgesia measured during labour (number of women satisfied or very satisfied after 30 minutes) IM pethidine vs placebo | RR 7 [0.38, 128.87] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Maternal pain score or pain measured in labour (described as good or fair after 1 hour) IM pethidine vs placebo | RR 1.75 [1.24, 2.47] | 1 study · 116 participants | Low Downgraded: risk of bias, imprecision |
Maternal pain score or pain measured in labour (reduction in VAS of at least 40 mm after 30 minutes) IM pethidine vs placebo | RR 25 [1.56, 400.54] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Additional analgesia required (epidural, pethidine and Entonox) IM pethidine vs placebo | RR 0.71 [0.54, 0.94] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Epidural IM pethidine vs placebo | RR 0.5 [0.14, 1.78] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Placebo and pethidine comparisons for pain management in labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal satisfaction with analgesia measured during labour (number of women satisfied or very satisfied after 30 minutes) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (described as good or fair after 1 hour) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (reduction in VAS of at least 40 mm after 30 minutes) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Additional analgesia required | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Epidural | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score measured during labour | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia (Analgesic effect described as satisfactory (not clear when measured)) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Maternal pain relief poor or none (3‐5 PN)) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain intensity 4 or 5 on 5‐point scale (1 hour)) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia in labour measured during the postnatal period (Global assessment of pain relief at 24 hours) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain intensity at 1 hour (moderate or severe)) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain intensity: women with poor pain relief) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Maternal pain relief poor at 1 hour) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia measured during labour (Pain relief (good or very good) at delivery) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain relief poor (partial, none or worse)) ‐ No add‐on drugs | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain relief poor (partial, none or worse)) ‐ With promazine | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Additional analgesia required ‐ pentazocine | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Additional analgesia required ‐ pentazocine + promazine | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia measured during the postnatal period (numbers dissatisfied) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia measured during labour (Pain free) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain intensity at 30 minutes: women with severe pain) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (VAS at 60 minutes (at peak of contraction)) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia (number of women satisfied or very satisfied) | no estimate extracted | NR | High |
Maternal satisfaction with analgesia measured during labour or during the postnatal period (Pain relief described as poor) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain relief at 30 mins | no estimate extracted | NR | High |
Maternal pain relief at 60 mins | no estimate extracted | NR | High |
Maternal pain score or pain measured in labour (after 30 mins) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (after 60 mins) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain score 30 mins post analgesia) | no estimate extracted | NR | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain score 1 hour post‐analgesia) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain intensity (Severe) after 1 hour) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain score 1 hour after drug administration) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Mean doses of analgesia (non pre‐specified) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia measured during labour (women with fair or poor relief) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain relief score) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (Pain score (1 hour after drug administration)) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia (assessed 3 days postpartum) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia, maternal pain score or pain measured in labour, additional analgesia, epidural | no estimate extracted | NR | No studies |
Maternal pan score or pain measured in labour | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pan score or pain measured in labour (rated as good one day after birth) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score in labour | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia in labour measured during the postnatal period (rated good or excellent) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal satisfaction with analgesia in labour measured during the postnatal period (Would use the same pain relief again) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternla pain score measured in labour | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score or pain measured in labour (measured 1 day after delivery) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Satisfied with mode of administration (PCA IM) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Opioids versus TENS | no estimate extracted | NR | No studies |
Maternal satisfaction with analgesia measured post delivery (rated as good) | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score measured during labour (after 30 minutes) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal pain score measured during labour (after 60 minutes) | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |