School of Nursing & Midwifery, Flinders University, Adelaide, SA, Australia.
Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, Australia.
BJOG. 2015 Jun;122(7):983-92. doi: 10.1111/1471-0528.13249. Epub 2015 Jan 5.
To compare the efficacy of fentanyl administered via the subcutaneous (s.c.) or intranasal (i.n.) route with intramuscular (i.m.) pethidine in labouring women requesting analgesia.
A randomised controlled trial three-armed, parallel-design.
A regional hospital and the largest tertiary maternity centre in South Australia.
One hundred and fifty-six healthy parturients birthing at term.
Women were randomised to receive s.c. fentanyl (n = 53), i.n. fentanyl (n = 52), or i.m. pethidine (n = 51). The outcomes were analysed by intention-to-treat.
Pain scores measured before and 30 minutes after opioid administration.
All groups reported clinically significant reductions in pain scores (mean range 1.2-1.6; P < 0.001), with no significant differences between groups. Significantly more women in the fentanyl groups reported satisfaction with using the study drug again, compared with women receiving i.m. pethidine (82.9% i.n. fentanyl, 80.6% s.c. fentanyl, and 44.0% i.m. pethidine; P < 0.01). Women in the fentanyl groups experienced less sedation (i.n. fentanyl 7.3%, s.c. fentanyl 2.9%, i.m. pethidine 44%; P ≤ 0.03), shorter labours by at least 2 hours (P < 0.05), and fewer difficulties establishing breastfeeding (78.8% i.m. pethidine, 39.4% i.n. fentanyl, and 44.0% s.c. fentanyl; P < 0.01). Neonates in the pethidine group were more likely to require nursery admission (P < 0.02).
Fentanyl administered by s.c. and i.n. routes is as efficacious in relieving labour pain as i.m. pethidine, but resulted in greater satisfaction, less sedation, shorter labour, fewer nursery admissions, and fewer difficulties in establishing breastfeeding. Fentanyl appears to be a suitable alternative to pethidine when providing parenteral pain relief to labouring women.
比较芬太尼经皮下（s.c.）或鼻内（i.n.）途径与肌肉内（i.m.）哌替啶在要求镇痛的产妇中的疗效。
一项随机对照三臂平行设计的试验。
南澳大利亚一家地区医院和最大的三级妇产中心。
156 名健康足月分娩的产妇。
将产妇随机分为接受 s.c.芬太尼（n = 53）、i.n.芬太尼（n = 52）或 i.m.哌替啶（n = 51）。通过意向治疗分析结局。
给药前和给药后 30 分钟的疼痛评分。
所有组均报告疼痛评分有临床意义的降低（平均范围 1.2-1.6；P < 0.001），组间无显著差异。与接受 i.m.哌替啶的女性相比，芬太尼组中有更多的女性报告再次使用研究药物满意（82.9% i.n.芬太尼、80.6% s.c.芬太尼和 44.0% i.m.哌替啶；P < 0.01）。芬太尼组的女性镇静程度更低（i.n.芬太尼 7.3%、s.c.芬太尼 2.9%、i.m.哌替啶 44%；P ≤ 0.03），分娩时间至少缩短 2 小时（P < 0.05），且建立母乳喂养的困难更少（78.8% i.m.哌替啶、39.4% i.n.芬太尼和 44.0% s.c.芬太尼；P < 0.01）。哌替啶组的新生儿更有可能需要入新生儿病房（P < 0.02）。
s.c.和 i.n.途径给予芬太尼与 i.m.哌替啶缓解分娩疼痛同样有效，但满意度更高，镇静程度更低，分娩时间更短，新生儿病房入住率更低，建立母乳喂养的困难更小。芬太尼似乎是产妇分娩时提供静脉内镇痛的哌替啶的合适替代品。
