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Pain relief in labour protocols

Kelly Madden, Philippa Middleton, Allan M Cyna, Mandy Matthewson, Leanne Jones
BACKGROUND: This review is one in a series of Cochrane reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. This review updates an earlier version of the review of the same title. OBJECTIVES: To examine the effectiveness and safety of hypnosis for pain management during labour and childbirth. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and the reference lists of primary studies and review articles...
2016: Cochrane Database of Systematic Reviews
Joanna Solek-Pastuszka, Edyta Zagrodnik-Ulan, Romuald Bohatyrewicz, Zbigniew Celewicz
Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable" and 60% describe the pain as "very intense". Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine...
2015: Anaesthesiology Intensive Therapy
Kelly Madden, Philippa Middleton, Allan M Cyna, Mandy Matthewson, Leanne Jones
BACKGROUND: This review is one in a series of Cochrane Reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. We examined the current evidence regarding the use of hypnosis for pain management during labour and childbirth. This review updates the findings regarding hypnosis from an earlier review of complementary and alternative therapies for pain management in labour into a stand-alone review...
2012: Cochrane Database of Systematic Reviews
Leanne Jones, Mohammad Othman, Therese Dowswell, Zarko Alfirevic, Simon Gates, Mary Newburn, Susan Jordan, Tina Lavender, James P Neilson
BACKGROUND: The pain that women experience during labour is affected by multiple physiological and psychosocial factors and its intensity can vary greatly.  Most women in labour require pain relief. Pain management strategies include non-pharmacological interventions (that aim to help women cope with pain in labour) and pharmacological interventions (that aim to relieve the pain of labour). OBJECTIVES: To summarise the evidence from Cochrane systematic reviews on the efficacy and safety of non-pharmacological and pharmacological interventions to manage pain in labour...
2012: Cochrane Database of Systematic Reviews
Nigel Lee, Peter Coxeter, Michael Beckmann, Joan Webster, Vanessa Wright, Tric Smith, Sue Kildea
BACKGROUND: Almost one third of women suffer continuous lower back pain during labour. Evidence from three systematic reviews demonstrates that sterile water injections (SWI) provide statistically and clinically significant pain relief in women experiencing continuous lower back pain during labour. The most effective technique to administer SWI is yet to be determined. Therefore, the aim of this study is to determine if the single injection SWI technique is no less effective than the routinely used four injection SWI method in reducing continuous lower back pain during labour...
2011: BMC Pregnancy and Childbirth
I Z Mackenzie, J Xu, C Cusick, H Midwinter-Morten, H Meacher, J Mollison, M Brock
OBJECTIVE: To assess the role of acupuncture for analgesia during labour. DESIGN: Double-blind study of manual, electro and sham acupuncture, and single-blind study comparing acupuncture with a control group for analgesia for labour induction. SETTING: A major obstetric unit in the UK. POPULATION: A cohort of 105 nulliparae undergoing labour induction at term. METHODS: Twenty-three subjects needed to be randomised to each group to have an 80% power of detecting a 50% relative reduction in epidural rate with an alpha value of 0...
March 2011: BJOG: An International Journal of Obstetrics and Gynaecology
R D Maimburg, M Vaeth, J Dürr, L Hvidman, J Olsen
OBJECTIVE: To compare the birth process in nulliparous women enrolled in a structured antenatal training programme, the 'Ready for Child' programme, with women allocated to routine care. DESIGN: A randomised controlled trial. SETTING: A Danish university hospital. PARTICIPANTS: Thousand hundred and ninety-three nulliparous women, recruited before week 22 + 0. Methods Compliance to the protocol was monitored by questionnaires sent to the women by email, and by data from the local birth cohort database...
July 2010: BJOG: An International Journal of Obstetrics and Gynaecology
K Saravanakumar, J S Garstang, K Hasan
BACKGROUND: Although regional techniques offer superior analgesia during labour, many women receive other methods of pain relief. Furthermore, there is a specific need for analgesia in a small population of labouring women for whom regional techniques are contraindicated, unavailable or impossible to perform. We surveyed current UK practice of labour analgesia for such patients, with particular reference to the use of intravenous patient-controlled analgesia. METHODS: Following approval from the Obstetric Anaesthetists' Association, a questionnaire was sent to the lead anaesthetic consultants of 243 obstetric units in the United Kingdom...
July 2007: International Journal of Obstetric Anesthesia
Christine L Roberts, Camille H Raynes-Greenow, Natasha Nassar, Lyndal Trevena, Kirsten McCaffery
BACKGROUND: Women report fear of pain in childbirth and often lack complete information on analgesic options prior to labour. Preferences for pain relief should be discussed before labour begins. A woman's antepartum decision to use pain relief is likely influenced by her cultural background, friends, family, the media, literature and her antenatal caregivers. Pregnant women report that information about analgesia was most commonly derived from hearsay and least commonly from health professionals. Decision aids are emerging as a promising tool to assist practitioners and their patients in evidence-based decision making...
December 9, 2004: BMC Pregnancy and Childbirth
S Torvaldsen, C L Roberts, J C Bell, C H Raynes-Greenow
BACKGROUND: Although epidural analgesia provides the most effective labour analgesia, it is associated with some adverse obstetric consequences, including an increased risk of instrumental delivery. Many centres discontinue epidural analgesia late in labour to improve a woman's ability to push and reduce the rate of instrumental delivery. OBJECTIVES: To assess the impact of discontinuing epidural analgesia late in labour on: i) rates of instrumental deliveries and other delivery outcomes; and ii) analgesia and satisfaction with labour care...
2004: Cochrane Database of Systematic Reviews
Rhona J McInnes, Edith Hillan, Diana Clark, Harper Gilmour
OBJECTIVES: To compare the efficacy of diamorphine administered by a patient-controlled pump (patient-controlled analgesia) with intramuscular administration for pain relief in labour. DESIGN: Randomised controlled trial. SETTING: The South Glasgow University Hospitals NHS Trust. SAMPLE: Primigravidae and multigravidae in labour at term (37-42 weeks). METHODS: Women were randomised in labour to the study (patient-controlled analgesia) or control group (intramuscular)...
October 2004: BJOG: An International Journal of Obstetrics and Gynaecology
B B Lee, P P Chen, W D Ngan Kee
OBJECTIVE: To examine the status of obstetric epidural analgesia services in Hong Kong public hospitals in 2001, and to compare findings with those from a similar survey conducted in 1995. DESIGN: Postal questionnaire survey. SETTING: Hospital Authority hospitals in Hong Kong offering an obstetric and delivery service. PARTICIPANTS: Chiefs of Service of departments of anaesthesia and coordinators of obstetric anaesthesia and analgesia service...
December 2003: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Mei-Yueh Chang, Shing-Yaw Wang, Chung-Hey Chen
AIMS: To investigate the effects of massage on pain reaction and anxiety during labour. BACKGROUND: Labour pain is a challenging issue for nurses designing intervention protocols. Massage is an ancient technique that has been widely employed during labour, however, relatively little study has been undertaken examining the effects of massage on women in labour. METHODS: A randomized controlled study was conducted between September 1999 and January 2000...
April 2002: Journal of Advanced Nursing
V Souron, L Simon, J Hamza
OBJECTIVES: To assess prophylactic and curative managements of dural taps occurring during the setting of epidural analgesia (EA) for labour. STUDY DESIGN: Nationwide French retrospective survey. PATIENTS AND METHODS: From April to July 1997, a questionnaire was sent to 799 French obstetrical units located in both teaching and non-teaching public hospitals and private institutions. RESULTS: Answers were obtained from 267 units (response rate of 33%)...
November 1999: Annales Françaises D'anesthèsie et de Rèanimation
S Adams
Pregnancy poses particular risks for women with sickle cell disease and their unborn babies. There is an increased risk of spontaneous abortion and preterm labour. Painful sickle cell crises tend to occur more frequently during pregnancy. A district-wide protocol for dealing with crises would help ensure the woman receives prompt, effective, knowledgeable care from GPs, midwives and A&E staff. Careful assessment is essential and hospital admission is usually required. Adequate relief of pain, and sometimes blood transfusions, are the cornerstones of treatment...
1996: Professional Care of Mother and Child
T Sajjad, T D Ryan
A postal survey of all maternity units in the UK was conducted to gain information regarding the management of inadvertent dural taps occurring during the sitting of epidurals for pain relief in labour. Of the units surveyed only 58.5% had a written protocol for the management of dural taps. Following their occurrence, 99% of the units resited the epidural and in 22%, the midwives continued to give the top-ups. In only one-third of this latter group was the dose of the top-up reduced. In 46% of the units, patients who had a dural tap were allowed to push in the second stage of labour...
February 1995: Anaesthesia
A Sheikh, M E Tunstall
A double-blind comparison of pethidine and meptazinol in the relief of pain during labour was undertaken in 205 healthy women. The protocol allowed 100 mg of the test drug to be repeated at intervals of 2 h to a maximum of three doses. It was noteworthy that only 29 mothers were given a second dose of narcotic. Every woman receiving one injection of meptazinol complained of moderate to severe pain after 2 h; 97% of those receiving one injection of pethidine were complaining of moderate to severe pain after 2 h...
March 1986: British Journal of Obstetrics and Gynaecology
C Dörfling, A G Nolte
Epidural anaesthesia as a method of pain relief during labour has lately become very popular. Statistics show that in some labour units up to 70 per cent of all patients undergo epidural anaesthesia. The popularity of this method can be attributed to its effectiveness in relieving pain during labour. The anaesthetist commences an epidural block by introducing an epidural catheter into the epidural space. The anaesthetist administers the test dose and the first therapeutic dose. Within a short duration of time (10 to 20 minutes) the patient can already experience the numbing effect of the anaesthetic...
December 1990: Curationis
M J Paech
A randomised, single-blind study to investigate patient-controlled epidural analgesia during labour was conducted using a solution of low-dose bupivacaine-fentanyl. Two groups (n = 25 in each) received a constant infusion supplemented by patient demand boluses, and midwife-administered boluses if required, the size of the infusion and patient increments varying between groups. The quality of analgesia, as assessed by pain scores and patient ratings, was high and participant acceptability very high in both groups...
February 1991: Anaesthesia and Intensive Care
S Arulkumaran, S S Ratnam
Training in perinatal care involves many different areas, and care around the time of labour forms a core part of training. Our senior residency programme involves 6 months supervised work in the labour ward. During this period, management of spontaneous, induced and augmented labour, methods of fetal monitoring and pain relief are taught. A log book and a check list are maintained to ensure the necessary manipulative and operative obstetric procedures have been followed. Limited scanning experience is provided to enable management of emergencies such as APH, multiple pregnancies, etc...
June 1992: Early Human Development
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