Rarely used painkiller can reduce the need for epidurals in pregnant women by half: Study
Pethidine is currently being given to about 250,000 women every year and 40% of them end up needing an epidural
A study has suggested that thousands of mothers in the UK could ditch epidurals if doctors in hospitals switched to a painkiller that is more effective. Experts have found that remifentanil, a drug that is not used much by the NHS, has been revealed to be more effective than pethidine, which is currently being given to about 250,000 women every year. Pethidine is administered to around a third of the women who give birth in the UK and it comes in the form of an injection. Even though the painkiller is given to the women, around 40% of them end up needing an epidural. The researchers have suggested that if remifentanil is more widely used in hospitals, it could go on to cut down the number of women needing epidurals by almost half.
An epidural involves inserting a local anesthetic into the mother-to-be in a space between two vertebrae in the spine. This allows all feeling to be temporarily removed from below the waist. the procedure is very effective for relieving pain but it is an invasive procedure that sometimes causes the labor to slow down and may also increase the chances of needing a forceps birth, the Daily Mail reported. This can also end up leading to more complications and the mother will probably end up spending more time in the hospital.
Using remifentanil instead of pethidine to relieve pain during labour could halve the number of women needing an epidural, an RCT has shown @TheLancet https://t.co/WvjLa13UxG pic.twitter.com/dLVkvJvh6J— The BMJ (@bmj_latest) August 14, 2018
The study, which was led by the Birmingham, Sheffield, and Nottingham universities, found out that using remifentanil instead of the usual pethidine reduced the number of epidurals in women from 41% to 19% which is more than half. They also found out that the average pain score in women that was reported during labor had been reduced in the group that was given remifentanil, which is given through a drip that women are able to control with a handheld device. The authors of the study have urged hospitals to use remifentanil more routinely based on the results.
The findings of the study, which had been funded by the NHS's National Institute for Health Research, was based on 400 women who gave birth at 14 different hospitals in the UK.
Dr. Matthew Wilson, the chief investigator of the University of Sheffield, said: "While pethidine is commonly used in labour, its effectiveness in terms of pain relief has long been challenged and its shortcomings are more serious when set against known side effects which include women feeling sedated and nauseous; it can also transfer to the baby via the placenta producing side effects."
The University of Birmingham's Professor Christine MacArthur then added: "While we were anticipating fewer women who had been given remifentanil patient-controlled analgesia (PCA) to go on to have an epidural, we did not expect to show that the epidural rate could be halved.
The results of the trial provide strong evidence that remifentanil PCA should be routinely offered as an alternative to pethidine and should be rolled out at hospitals across the UK. Not only would it provide women with a more effective pain relief option in labour, it could significantly reduce the number of epidurals and the associated higher rates of instrumental births, in turn potentially reducing the financial burden on the NHS."
Dr. Wilson mentioned that there "was also no difference in the health of babies born to women who received remifentanil". Dr. Pat O'Brien from the Royal College of Obstetricians and Gynaecologists, however, has stressed caution. He said: "While this is a large study, more research will be needed to replicate these findings and change standard of clinical practice but it does offer evidence which can be used in discussions between a woman and her midwife and/or obstetrician when making a decision about which pain relief to use during birth."