科研之友
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摘要
ObjectiveIntramuscular (i.m.) pethidine is used worldwide for labour analgesia and i.m. diamorphine usage has increased in the UK in the last 15years. This trial aims to ascertain the relative efficacy and adverse effects of diamorphine and pethidine for labour pain. DesignProspective, parallel-arm randomised controlled trial with blinding of participants, care-givers and outcome assessors. SettingMaternity units in two District General Hospitals in the UK. PopulationAfter written informed consent, 484 women were randomised and recruited (244 diamorphine, 240 pethidine). Inclusion criteria included women 16years or older, established labour, singleton pregnancy, 37-42weeks of gestation and weight 60-120kg. MethodsOn request of i.m. analgesia, participants received either 150mg pethidine or 7.5mg diamorphine based on computer-generated block randomisation. Main outcome measuresMaternalreduction in pain intensity from baseline (10-cm visual analogue scale) at 60minutes and over the 3-hour period after drug administration. Neonatalrequirement for resuscitation and Apgar score at 1minute. ResultsDiamorphine provided modestly improved pain relief at 60minutes, mean difference 1cm (95% confidence interval [CI] 0.5-1.5), and over the 3hours, mean difference 0.7cm (95% CI 0.3-1.1). However, average length of labour in women receiving diamorphine was 82minutes longer (95% CI 39-124) and therefore they experienced more pain overall. There were no statistically significant differences in primary neonatal outcomes. ConclusionsThere is a modest difference between the analgesia provided by diamorphine or pethidine for labour analgesia but diamorphine is associated with significantly longer labours.
- 出版日期2014-3
