Inhaled Analgesia Eases Pain in Early Labor Inhaled Analgesia Eases Pain in Early Labor

Inhaled analgesia using nitrous oxide (NO2) or a flurane-derivative is a useful option for women in labor, particularly for those who are unable or unwilling to undergo more invasive analgesic procedures, according to a new study.

Researchers at the Midwifery Academy of Amsterdam (The Netherlands) searched the Cochrane Pregnancy and Childbirth Group’s Trials Register, ClinicalTrials.gov, Current Controlled Trials, and other sources to examine the effects of all modalities of inhaled analgesia on the mother and the newborn in vaginal delivery. In all, 26 studies, randomizing 2,959 women, were included. Pain relief and pain intensity were measured using Visual Analogue Scales (VASs); the highest score for pain relief was the most positive, in contrast to pain intensity, in which the higher score was more negative.

The results showed that flurane derivatives offered better pain relief than NO2 in first stage of labor, as measured by a lower pain intensity score, as well as a higher pain relief score, but more nausea was found in the NO2 group compared with the flurane derivatives group. Placebo or no treatment was found to offer less pain relief compared to NO2, but resulted in more side effects for women such as nausea, vomiting, dizziness, and drowsiness compared with placebo or no treatment. The study was published online on September 12, 2102, in the Cochrane Database of Systematic Reviews.

“While the use of epidural analgesia has become increasingly popular, it increases costs and is not without side effects, so other options are desirable,” concluded lead author Trudy Klomp, MSc, and colleagues. “Even in hospitals with full-time obstetric anesthesia coverage, no one may be available to place an epidural, provide another highly effective method of labor analgesia, or provide a labor-intensive nonpharmacological method to help the woman in pain.”

While the study suggests that inhaled analgesia with flurane derivatives during the first stage of labor provides greater pain relief with less nausea than NO2, NO2 can be easily self-administered, while the flurane derivatives must be given by an anesthesia professional.

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Midwifery Academy of Amsterdam