Labor pain management

Connelly NR, Mainkar T, El-Mansouri M, Manikantan P, Venkata RR, Dunn S, Parker RK. Effect of epidural cloni-dine added to epidural sufentanil for labor pain management. Int J Obstet Anesth 2000 9(2) 94-8. 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

American obstetricians used nitrous oxide as a common pain management tool for women in labor through the early 1970s. Today, the anesthetic has been largely replaced in the United States, but a 50/50 mix of nitrous oxide and oxygen is still the anesthetic of choice for women in labor in the UK—over 60% use the gas for pain relief. 

In potency, pethidine is graded between codeine and morphine (50-100 mg is equivalent to 10 mg morphine in man),(2) and it is useful for the management of mild to moderate pain, especially in patients intolerant to opioids. Its toxicity is relatively low and its duration of action is somewhat shorter than that of morphine. At equivalent dosage, pethidine is at least as depressant as morphine upon respiration and while morphinelike side effects such as nausea and vomiting frequently occur, it produces little disturbance of urinary function or bowel action. It is extensively used for the relief of labor pain even though it increases the incidence of delay on the first breath and cry of the neonate (3) several critical reports on the efficacy of the drug in obstetrics have been made.(4) Tolerance to pethidine develops slowly, and its dependence liability is claimed to be lower than that of morphine.(5) Full accounts of the clinical use of pethidine are available.(4,6)... 

Use Provides symptomatic relief of allergic symptoms sedative/ antiemetic in surgery/labor decreases postop nausea/ vomiting adjunct to analgesics in control of pain management of motion sickness. Half-life UK minutes IM 20 minutes Rectal 20 minutes IV 3-5 minutes Onset PO 20 Peaks Duration 1-4 hours PO/IM Rectal/TV 2-8 hours... 

Leeman L, Fontaine R King V, et al. The nature and management of labor pain 1. Nonpharmacologic pain relief. Am Fam Rhys 2003 68 1109-1112. 

Parenteral management of moderate-to-severe pain pre-operative medication, a supplement to balanced anesthesia, management of pain during labor, anesthesia. 

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