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M Wilson - One of the best experts on this subject based on the ideXlab platform.
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qualitative exploration of women s experiences of intramuscular Pethidine or remifentanil patient controlled analgesia for labour pain
BMJ Open, 2019Co-Authors: Victoria Hall Moran, Christine Macarthur, Leanne Beeson, Gillian Thomson, Julie Cook, Hannah Storey, M WilsonAbstract:Objectives To explore women’s experiences of remifentanil or Pethidine for labour pain and infant feeding behaviours at 6weeks post partum. Design Qualitative postnatal sub-study to the randomised controlled trial of remifentanil intravenous patient controlled analgesia (PCA) versus intramuscular Pethidine for pain relief in labour (RESPITE). Semistructured telephone interviews were conducted at 6 weeks post partum, and thematic analysis was undertaken. Setting Women recruited to the RESPITE trial from seven UK hospitals. Participants Eighty women consented and 49 (30 remifentanil group and 19 Pethidine group) completed the interview. Results Eight themes emerged which encompassed women’s antenatal plans for pain management (Birth Expectations) through to their future preferences for pain relief (Reflections for Future Choices). Many women who used remifentanil felt it provided effective pain relief (Effectiveness of Pain Relief), whereas women in the Pethidine group expressed more mixed views. Both groups described side effects, with women using Pethidine frequently reporting nausea (Negative Physiological Responses) and women using remifentanil describing more cognitive effects (Cognitive Effects). Some women who used remifentanil reported restricted movements due to technical aspects of drug administration and fear of analgesia running out (Issues with Drug Administration). Women described how remifentanil enabled them to maintain their ability to stay focused during the birth (Enabling a Sense of Control). There was little difference in reported breastfeeding initiation and continuation between Pethidine and remifentanil groups (Impact on Infant Behaviour and Breastfeeding). Conclusions Qualitative insights from a follow-up study to a trial which explored experiences of intravenous remifentanil PCA with intramuscular Pethidine injection found that remifentanil appeared to provide effective pain relief while allowing women to remain alert and focused during labour, although as with Pethidine, some side effects were noted. Overall, there was little difference in reported breastfeeding initiation and duration between the two groups. Trial registration number ISRCTN29654603.
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intravenous remifentanil patient controlled analgesia versus intramuscular Pethidine for pain relief in labour respite an open label multicentre randomised controlled trial
The Lancet, 2018Co-Authors: M Wilson, Christine Macarthur, Catherine A Hewitt, Kelly Handley, Fang Gao, Leanne Beeson, Jane DanielsAbstract:Summary Background About a third of women receiving Pethidine for labour pain subsequently require an epidural, which provides effective pain relief but increases the risk of instrumental vaginal delivery. Remifentanil patient-controlled analgesia (PCA) in labour is an alternative to Pethidine, but is not widely used. We aimed to evaluate epidural analgesia progression among women using remifentanil PCA compared with Pethidine. Methods We did an open-label, multicentre, randomised controlled trial in 14 UK maternity units. We included women aged 16 years or older, beyond 37 weeks' gestation, in labour with a singleton cephalic presentation, and who requested opioid pain relief. We randomly assigned eligible participants (1:1) to either the intravenous remifentanil PCA group (40 μg bolus on demand with a 2 min lockout) or the intramuscular Pethidine group (100 mg every 4 h, up to 400 mg in 24 h), using a web-based or telephone randomisation service with a minimisation algorithm for parity, maternal age, ethnicity, and mode of labour onset. Because of the differences in routes of drug administration, study participants and health-care providers were not masked to the group allocation. The primary outcome was the proportion of women who received epidural analgesia after enrolment for pain relief in labour. Primary analyses were unadjusted and analysed by the intention-to-treat principle. This study is registered with the ISRCTN registry, number ISRCTN29654603. Findings Between May 13, 2014, and Sept 2, 2016, 201 women were randomly assigned to the remifentanil PCA group and 200 to the Pethidine group. One participant in the Pethidine group withdrew consent, leaving 199 for analyses. The proportions of epidural conversion were 19% (39 of 201) in the remifentanil PCA group and 41% (81 of 199) in the Pethidine group (risk ratio 0·48, 95% CI 0·34–0·66; p Interpretation Intravenous remifentanil PCA halved the proportion of epidural conversions compared with intramuscular Pethidine. This finding challenges routine Pethidine use as standard of care in labour. Funding National Institute for Health Research Clinician Scientist Award.
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the respite trial remifentanil intravenously administered patient controlled analgesia pca versus Pethidine intramuscular injection for pain relief in labour study protocol for a randomised controlled trial
Trials, 2016Co-Authors: M Wilson, Christine Macarthur, Kelly Handley, Fang Gao Smith, Leanne Homer, Jane P DanielsAbstract:The commonest opioid used for pain relief in labour is Pethidine (meperidine); however, its effectiveness has long been challenged and the drug has known side effects including maternal sedation, nausea and potential transfer across the placenta to the foetus. Over a third of women receiving Pethidine require an epidural due to inadequate pain relief. Epidural analgesia increases the risk of an instrumental vaginal delivery and its associated effects. Therefore, there is a clear need for a safe, effective, alternative analgesic to Pethidine. Evidence suggests that remifentanil patient-controlled analgesia (PCA) reduces epidural conversion rates compared to Pethidine; however, no trial has yet investigated this as a primary endpoint. We are, therefore, comparing Pethidine intramuscular injection to remifentanil PCA in a randomised controlled trial. Women in established labour, requesting systemic opioid pain relief, will be randomised to either intravenously administered remifentanil PCA (intervention) or Pethidine intramuscular injection (control) in an unblinded, 1:1 individual randomised trial. Following informed consent, 400 women in established labour, who request systemic opioid pain relief, from NHS Trusts across England will undergo a minimised randomisation by a computer or automated telephone system to either Pethidine or remifentanil. In order to balance the groups this minimisation is based on four parameters; parity (nulliparous versus multiparous), maternal age (<20, 20 < 30, 30 < 40, 40+ years), ethnicity (South Asian (Pakistani/Indian/Bangladeshi) versus Other) and induced versus spontaneous labour. The effectiveness of pain relief provided by each technique will be recorded every 30 min after time zero, until epidural placement, delivery or transfer to theatre, quantified by Visual Analogue Scale. Incidence of maternal side effects including sedation, delivery mode, foetal distress requiring delivery, neonatal status at delivery and rate of initiation of breastfeeding within the first hour of birth will also be recorded. Maternal satisfaction with her childbirth experience will be determined by a postpartum questionnaire prior to discharge from the delivery ward. The RESPITE trial’s primary outcome is the proportion of women who have an epidural placed for pain relief in labour in each arm. Current Controlled Trials registration number: ISRCTN29654603 . Registered on 23 July 2013.
Christine Macarthur - One of the best experts on this subject based on the ideXlab platform.
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qualitative exploration of women s experiences of intramuscular Pethidine or remifentanil patient controlled analgesia for labour pain
BMJ Open, 2019Co-Authors: Victoria Hall Moran, Christine Macarthur, Leanne Beeson, Gillian Thomson, Julie Cook, Hannah Storey, M WilsonAbstract:Objectives To explore women’s experiences of remifentanil or Pethidine for labour pain and infant feeding behaviours at 6weeks post partum. Design Qualitative postnatal sub-study to the randomised controlled trial of remifentanil intravenous patient controlled analgesia (PCA) versus intramuscular Pethidine for pain relief in labour (RESPITE). Semistructured telephone interviews were conducted at 6 weeks post partum, and thematic analysis was undertaken. Setting Women recruited to the RESPITE trial from seven UK hospitals. Participants Eighty women consented and 49 (30 remifentanil group and 19 Pethidine group) completed the interview. Results Eight themes emerged which encompassed women’s antenatal plans for pain management (Birth Expectations) through to their future preferences for pain relief (Reflections for Future Choices). Many women who used remifentanil felt it provided effective pain relief (Effectiveness of Pain Relief), whereas women in the Pethidine group expressed more mixed views. Both groups described side effects, with women using Pethidine frequently reporting nausea (Negative Physiological Responses) and women using remifentanil describing more cognitive effects (Cognitive Effects). Some women who used remifentanil reported restricted movements due to technical aspects of drug administration and fear of analgesia running out (Issues with Drug Administration). Women described how remifentanil enabled them to maintain their ability to stay focused during the birth (Enabling a Sense of Control). There was little difference in reported breastfeeding initiation and continuation between Pethidine and remifentanil groups (Impact on Infant Behaviour and Breastfeeding). Conclusions Qualitative insights from a follow-up study to a trial which explored experiences of intravenous remifentanil PCA with intramuscular Pethidine injection found that remifentanil appeared to provide effective pain relief while allowing women to remain alert and focused during labour, although as with Pethidine, some side effects were noted. Overall, there was little difference in reported breastfeeding initiation and duration between the two groups. Trial registration number ISRCTN29654603.
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intravenous remifentanil patient controlled analgesia versus intramuscular Pethidine for pain relief in labour respite an open label multicentre randomised controlled trial
The Lancet, 2018Co-Authors: M Wilson, Christine Macarthur, Catherine A Hewitt, Kelly Handley, Fang Gao, Leanne Beeson, Jane DanielsAbstract:Summary Background About a third of women receiving Pethidine for labour pain subsequently require an epidural, which provides effective pain relief but increases the risk of instrumental vaginal delivery. Remifentanil patient-controlled analgesia (PCA) in labour is an alternative to Pethidine, but is not widely used. We aimed to evaluate epidural analgesia progression among women using remifentanil PCA compared with Pethidine. Methods We did an open-label, multicentre, randomised controlled trial in 14 UK maternity units. We included women aged 16 years or older, beyond 37 weeks' gestation, in labour with a singleton cephalic presentation, and who requested opioid pain relief. We randomly assigned eligible participants (1:1) to either the intravenous remifentanil PCA group (40 μg bolus on demand with a 2 min lockout) or the intramuscular Pethidine group (100 mg every 4 h, up to 400 mg in 24 h), using a web-based or telephone randomisation service with a minimisation algorithm for parity, maternal age, ethnicity, and mode of labour onset. Because of the differences in routes of drug administration, study participants and health-care providers were not masked to the group allocation. The primary outcome was the proportion of women who received epidural analgesia after enrolment for pain relief in labour. Primary analyses were unadjusted and analysed by the intention-to-treat principle. This study is registered with the ISRCTN registry, number ISRCTN29654603. Findings Between May 13, 2014, and Sept 2, 2016, 201 women were randomly assigned to the remifentanil PCA group and 200 to the Pethidine group. One participant in the Pethidine group withdrew consent, leaving 199 for analyses. The proportions of epidural conversion were 19% (39 of 201) in the remifentanil PCA group and 41% (81 of 199) in the Pethidine group (risk ratio 0·48, 95% CI 0·34–0·66; p Interpretation Intravenous remifentanil PCA halved the proportion of epidural conversions compared with intramuscular Pethidine. This finding challenges routine Pethidine use as standard of care in labour. Funding National Institute for Health Research Clinician Scientist Award.
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the respite trial remifentanil intravenously administered patient controlled analgesia pca versus Pethidine intramuscular injection for pain relief in labour study protocol for a randomised controlled trial
Trials, 2016Co-Authors: M Wilson, Christine Macarthur, Kelly Handley, Fang Gao Smith, Leanne Homer, Jane P DanielsAbstract:The commonest opioid used for pain relief in labour is Pethidine (meperidine); however, its effectiveness has long been challenged and the drug has known side effects including maternal sedation, nausea and potential transfer across the placenta to the foetus. Over a third of women receiving Pethidine require an epidural due to inadequate pain relief. Epidural analgesia increases the risk of an instrumental vaginal delivery and its associated effects. Therefore, there is a clear need for a safe, effective, alternative analgesic to Pethidine. Evidence suggests that remifentanil patient-controlled analgesia (PCA) reduces epidural conversion rates compared to Pethidine; however, no trial has yet investigated this as a primary endpoint. We are, therefore, comparing Pethidine intramuscular injection to remifentanil PCA in a randomised controlled trial. Women in established labour, requesting systemic opioid pain relief, will be randomised to either intravenously administered remifentanil PCA (intervention) or Pethidine intramuscular injection (control) in an unblinded, 1:1 individual randomised trial. Following informed consent, 400 women in established labour, who request systemic opioid pain relief, from NHS Trusts across England will undergo a minimised randomisation by a computer or automated telephone system to either Pethidine or remifentanil. In order to balance the groups this minimisation is based on four parameters; parity (nulliparous versus multiparous), maternal age (<20, 20 < 30, 30 < 40, 40+ years), ethnicity (South Asian (Pakistani/Indian/Bangladeshi) versus Other) and induced versus spontaneous labour. The effectiveness of pain relief provided by each technique will be recorded every 30 min after time zero, until epidural placement, delivery or transfer to theatre, quantified by Visual Analogue Scale. Incidence of maternal side effects including sedation, delivery mode, foetal distress requiring delivery, neonatal status at delivery and rate of initiation of breastfeeding within the first hour of birth will also be recorded. Maternal satisfaction with her childbirth experience will be determined by a postpartum questionnaire prior to discharge from the delivery ward. The RESPITE trial’s primary outcome is the proportion of women who have an epidural placed for pain relief in labour in each arm. Current Controlled Trials registration number: ISRCTN29654603 . Registered on 23 July 2013.
J P H Fee - One of the best experts on this subject based on the ideXlab platform.
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patient controlled analgesia for labour a comparison of remifentanil with Pethidine
Anaesthesia, 2005Co-Authors: J M Blair, G T Dobson, D A Hill, G R Mccracken, J P H FeeAbstract:Summary We compared the analgesic efficacy and safety of remifentanil and Pethidine via patient controlled analgesia for women in established uncomplicated labour. Women received either remifentanil 40 μg with a 2-min lockout (n = 20) or Pethidine 15 mg with a 10-min lockout (n = 19). Visual analogue scores for pain during the study and for overall pain were similar for both groups (mean (SD) 6.4 (1.5) cm for remifentanil and 6.9 (1.7) cm for Pethidine). The area under the curve for visual analogue scores of satisfaction with analgesia was higher for remifentanil than for Pethidine (p = 0.001). Maternal arterial oxygen saturation was similar in both groups. Neurologic and Adaptive Capacity Scores at 30 min were higher for remifentanil than for Pethidine (median (interquartile range [range]) 36 (34.5–37 [32–39]) vs 34 (33–35 [30–35]), respectively; p = 0.003).
Rui Wang - One of the best experts on this subject based on the ideXlab platform.
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effects of rat mouse hemokinin 1 a mammalian tachykinin peptide on the antinociceptive activity of Pethidine administered at the peripheral and supraspinal level
Behavioural Brain Research, 2007Co-Authors: Xiaolong Tang, Qi Yang, Qiang Chen, Rui WangAbstract:We have recently reported that rat/mouse hemokinin-1 (r/m HK-1), a mammalian tachykinin, produced dose- and time-related antinociceptive effects at the supraspinal level via activating NK1 receptors. Moreover, r/m HK-1 remarkably enhanced both the antinociceptive extent and duration of morphine administered at the peripheral and supraspinal level through a convergence of pharmacological effects of opioid-responsive neurons. Pethidine hydrochloride is an important narcotic analgesic, which acts as an opiate agonist and has pharmacological effects similar to morphine. To improve our knowledge of the pharmacology of Pethidine, the aim of the present study was to investigate the relationship between the nociception of r/m HK and Pethidine by comparing it with that of r/m HK-1 and morphine. Our data showed that r/m HK-1 remarkably enhanced the antinociceptive extent of Pethidine administered at the peripheral level, but not at the supraspinal level. These antinociceptive effects were blocked by prior treatment with the classical opioid receptor antagonist naloxone, indicating that the potentiated analgesic effect is mediated by opioid-responsive neurons. Differences in the antinociceptive activity of Pethidine and morphine in combination with r/m HK-1, arise because there are differences in the physicochemical and pharmacokinetic properties of Pethidine and morphine, particularly their lipophilicity. Our results may pave the way for a new strategy for the control of pain and may provide a clinical strategy to enable selection of either opioid as a priority.
Matthew T V Chan - One of the best experts on this subject based on the ideXlab platform.
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a double blind randomised comparison of intravenous patient controlled remifentanil with intramuscular Pethidine for labour analgesia
Anaesthesia, 2011Co-Authors: B C P Cheng, W S Chan, K K Lam, Matthew T V ChanAbstract:Summary In a prospective, double-blind, randomised controlled trial, we compared the efficacy of patient-controlled analgesia using remifentanil (25–30 μg per bolus) with intramuscular Pethidine (50–75 mg) for labour analgesia in 69 parturients. Parturients receiving patient-controlled analgesia reported less pain than those receiving intramuscular Pethidine throughout the study period (p < 0.001), with maximal reduction in visual analogue pain score at 2 h after commencement of analgesia (mean (SD) 20 (17) in the patient-controlled analgesia group and 36 (22) in the intramuscular Pethidine group. The median (95% CI) time to the first request for rescue analgesics was significantly longer with patient-controlled analgesia (8.0 (6.8–9.2) h) compared with intramuscular Pethidine (4.9 (3.8–5.4) h, p < 0.001). Maternal satisfaction scores were also higher with remifentanil compared with intramuscular Pethidine (p= 0.001). There was no report of sedation, aponea or oxygen desaturation in either group, and Apgar scores were similar between groups. We conclude that patient-controlled analgesia with remifentanil provides better labour analgesia and maternal satisfaction than intramuscular Pethidine. At this dose, maternal and fetal side effects were uncommon.