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Changing the drug used during labour could halve the number of women needing an epidural

Pethidine is the most widely used drug but new research suggests remifentanil may work better.

Image: Shutterstock/lavizzara

A NEW STUDY has suggested that a less widely used labour pain relief drug could be more effective for women than the one used in most Irish and UK hospitals.

The research looked at the drug remifentanil and found that women who were given it were half as likely to subsequently request an epidural than those who used pethidine.

Epidurals, which involve injections of pain relief drugs around the spinal cord, provide effective pain relief but increase the chances that a forceps or vacuum are used during birth.

This may in turn increase the risk of some long-lasting problems for the mother.

In the trial, 200 women who requested opioid pain relief were allocated pethidine and 200 were given remifentanil. All of the women involved in the trial were giving birth after 37 weeks of pregnancy.

All of the women were also given one-to-one care from a midwife and could request an epidural at any time after their initial medication.

Of those who were given pethidine, 41% of the women went on to have an epidural while just 19% of those who had remifentanil did so.

The study also found that the women in the remifentanil group rated their pain as less severe than women in the pethidine group.

However, even though breathing problems were reported as rare in both groups , those who were given remifentanil were twice as likely to have low oxygen levels that required them to be given supplemental oxygen.

Although pethidine is a widely used labour pain relief drug, the HSE has previously noted that it “does not work for everyone” and may be associated with feelings of nausea.

The authors of the report have stated that this is an additional reason why remifentanil may be a better option.

“Previous studies have shown that at least one in three women given pethidine to manage pain during labour require a subsequent epidural, as the drug is not always effective,” says Dr Matthew Wilson of the University of Sheffield.

“Remifentanil reduced the need for an epidural by half and there were no lasting problems for the mothers and babies in our trial, although the effect of remifentanil on maternal oxygen levels needs to be clarified in further studies.”

The study was jointly conducted by the University of Sheffield, University of Birmingham, Queen Elizabeth Hospital and the University of Nottingham with the results published in The Lancet journal.

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Rónán Duffy

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