School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.
Midwifery. 2011 Feb;27(1):e106-13. doi: 10.1016/j.midw.2009.11.002. Epub 2010 Jan 13.
to investigate the use of fentanyl for pain relief during childbirth administered by routes other than epidural or spinal (non-axial). In particular, aspects relating to the efficacy and safety of fentanyl for mother and neonate are explored.
currently, pethidine is the most widely used intramuscular opioid for the relief of labour pain but has been shown to have numerous side-effects on the mother and neonate. An alternative opioid, fentanyl, has been shown to have fewer side-effects on both mother and neonate than pethidine. Therefore, its use during childbirth was examined in this literature review.
a search of articles relating to the administration of fentanyl via non-axial routes was conducted using electronic databases, key journals and reference lists of selected research papers and reviews.
only studies of IV administration were identified from the literature findings from showed that IV administered fentanyl appeared to be a safe, efficacious opioid when administered for pain relief in childbirth. Fentanyl is a short-acting analgesic causing less sedation and nausea in adults than pethidine. In addition, no long-term fetal or neonatal effects of fentanyl were identified, with normal neonatal neurological and adaptive capacities at two hours and 24 hours after birth supporting its safe use in childbirth.
in the studies identified, fentanyl was found to be efficacious, providing prompt analgesia with minimal side-effects to both mother and infant when administered intravenously (IV) during childbirth. In addition, no long-term fetal effects were found. RECOMMENDATIONS FOR FURTHER RESEARCH: there is a paucity of research relating to the maternal, fetal and neonatal effects of non-axial administered fentanyl other than that of IV. Further research should explore alternate routes of administration such as subcutaneous, sublingual and nasal which are less invasive and can be administered by midwives.
in confirming the safe use of non-axial administration of fentanyl during childbirth, benefits include midwives being able to offer women an alternative option for pain relief. Alternative routes, such as subcutaneous, can be managed by midwives through a standing order, potentially reducing the need for additional resources. In particular, this will benefit midwifery practice in rural and remote settings where resources and access to specialised services are limited.
研究分娩时通过硬膜外或脊髓以外途径（非轴向）给予芬太尼缓解疼痛的效果。特别探讨了芬太尼对母亲和新生儿的疗效和安全性。
目前，哌替啶是缓解分娩疼痛最常用的肌肉内阿片类药物，但已显示出对母亲和新生儿有许多副作用。另一种阿片类药物芬太尼对母亲和新生儿的副作用比哌替啶少。因此，在本文献综述中检查了其在分娩中的应用。
使用电子数据库、主要期刊以及选定研究论文和综述的参考文献列表，对芬太尼通过非轴向途径给药的文章进行了检索。
仅从文献中发现了静脉内给药的研究结果，表明静脉内给予芬太尼似乎是一种安全有效的阿片类药物，用于分娩时缓解疼痛。芬太尼是一种短效镇痛药，在成人中引起的镇静和恶心作用比哌替啶少。此外，未发现芬太尼对胎儿或新生儿有长期影响，出生后 2 小时和 24 小时新生儿的神经和适应能力正常，支持其在分娩中的安全使用。
在所确定的研究中，芬太尼被发现是有效的，当在分娩时静脉内（IV）给予时，对母亲和婴儿都能迅速缓解疼痛，且副作用最小。此外，未发现长期胎儿影响。
除静脉内给药外，关于非轴向给予芬太尼对母亲、胎儿和新生儿的影响的研究很少。应进一步研究其他给药途径，如皮下、舌下和鼻内，这些途径侵入性较小，可由助产士管理。
在确认分娩时非轴向给予芬太尼的安全性的同时，好处包括助产士能够为妇女提供另一种疼痛缓解选择。替代途径，如皮下途径，可以通过常规医嘱由助产士管理，可能减少对额外资源的需求。特别是，这将有利于资源有限且难以获得专业服务的农村和偏远地区的助产实践。
