Natural Solution for Early Labor Pain

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From

Clinician Reviews®

In House - Natural Solution for Early Labor Pain

[Clinician Reviews 9(9):111-121, 1999. © 1999 Clinicians Publishing Group and

& Wilkins.]

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The hospital and surgical settings are among the most important current

growth areas for physician assistants and nurse practitioners. In House:

Hospital & Surgical Update covers major advances in hospital and surgical

patient management, as reported in peer-reviewed journals as well as at major

conferences and symposia. Although In House is designed primarily to address

the needs of the growing numbers of surgical and hospital-based PAs and NPs,

the information in this feature is of importance to all clinicians.

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Effective relief for the severe low back pain of early labor may be as

" natural " as water, report Swedish researchers. However, whether sterile

water is injected intracutaneously -- as has been demonstrated previously --

or subcutaneously, treatment carries one significant drawback: intense,

transient pain during administration.

Of 99 pregnant women, Mårtensson and Wallin randomized 33 to receive four

intracutaneous injections of 0.1 mL of sterile, salt-free water; 33 to be

given four subcutaneous injections of 0.5 mL of sterile water; and 33 to

receive four subcutaneous injections of 0.1 mL of isotonic saline (placebo).

Injections were administered in the lumbosacral region during a contraction

in the first stage of labor. All women were given nitrous oxide and oxygen to

breathe during injections.

Both intracutaneous and subcutaneous water injections led to significant

reductions in labor pain that lasted for 45 to 90 minutes, the researchers

reported recently in the British Journal of Obstetrics and Gynaecology.

According to the women's reports of pain using a 10-cm visual analog scale

that was administered 10 minutes after treatment, intracutaneous injections

led to a 5.0-cm reduction in pain, and subcutaneous injections to a 4.5-cm

reduction -- compared with a 1.7-cm reduction in the placebo group. At 45

minutes, the corresponding median reductions in pain were 4.9 cm, 4.0 cm, and

1.0 cm, respectively. Reductions in pain were no longer significant at 90

minutes; but by that time, sample size had decreased dramatically: 1 woman

was delivered within 10 minutes of treatment, 8 women within 45 minutes, and

15 women within 90 minutes.

Contrary to the researchers' expectations, subcutaneous injections -- the

newer route of administration -- were no less painful than intracutaneous

injections. Patients given placebo experienced less pain during

administration than did patients in the active treatment groups.

Nevertheless, the authors write, " If in need of treatment in the future, the

women in the two study groups were significantly more enthusiastic about

their treatment than those in the placebo group. "

Mårtensson L, Wallin G. Labour pain treated with cutaneous injections of

sterile water: a randomised controlled trial. Br J Obstet Gynaecol.

1999;106:633-637.