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Blog Archive

Blog Archive

Fentanyl vs. pethidine

January 2016

For the new year, I will be posting at the beginning of each week a published study that could impact your practice in the Mother-Baby Unit. It will be called "For Your Consideration." Whenever possible, I will post a link for you to be able to download the article. When not available, I will post as much information about accessing the article as possible.

This week, we begin with a recently posted study on pain relief during labor, pitting fentanyl with pethidine.

This 2015 Australian study randomized 156 laboring women to receive subcutaneous fentanyl, intranasal fentanyl, or intramuscular pethidine. The sc fentanyl group received a 200 microgram initial bolus with 50 microgram as requested, every 15 mins., with a maximum of 650 micrograms. Injections were given in subclavicular or upper pectoral regions. The in fentanyl group self-administered 54 micrograms into the nose using a patient-controlled intranasal analgesia device, with a 4 min. lockout time. The maximum dosage allowed was 1200 micrograms. Finally, the im pethidine group was administered 100 mg/2ml as a deep im injection into the ventrogluteal muscle. The dose could be repeated after 3-4 hours, with a maximum total dose of 200 mg.

Results with all three routes of labor pain medications showed significant pain reduction. However, the two groups receiving fentanyl experienced less sedation and shorter labor durations. As well, the infants born to mothers in the fentanyl groups had significantly fewer nursery admissions and less difficulty in establishing breastfeeding. The intranasal route is non-invasive, allows for the patient to give herself the doses, makes administration easy, provides the safety of a controlled dose, and has high patient acceptability. The authors conclude with, "Although pethidine continues to be the most commonly administered opioid in obstetrics, it is no longer the preferred option for most acute care settings. Newer opioid derivatives such as fentanyl are favored, because of the short onset time for pain relief and clearance. In particular, intranasal fentanyl has been shown to have a similar safety profile for children and adults in both the pre-hospital and hospital settings, yet to date, few studies have examined the use of fentanyl in childbirth," (2015, Fleet, Belan, Jones, Ullah, and Cyna).

Do your facilities utilize the subcutaneous or intranasal routes for labor pain control? Or is epidural the only route used? Please share what goes on in your locations, and discuss this article here on the Discussion Board. I'm really interested to hear your thoughts.


Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA
Course Tutor, Step2 Education



Fleet, J., Belan, I., Jones, M. J., Ullah, S., and Cyna, A. M. (2015). A comparison of fentanyl with pethidine for pain relief during childbirth: A randomized controlled trial. BJOG; 122:983-992.

I was able to download this article at Researchgate, where your membership is free. https://www.researchgate.net




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