Oral Paracetamol versus Oral Paracetamol with Codeine as Intrapartum Analgesic in the First Stage of Labor: Randomized Controlled Trial

Abstract

Abstract Background Labor pain includes components that differ completely from pain in general. It is the result of natural events and has a special meaning, leading in most cases to something extremely positive, the birth of a healthy child. Labor is a painful condition, considered to be one of the most intense and stressful experiences especially for nulliparous women. Although studies have found significant rise in pain threshold during labor. It is nonetheless an important goal to provide safe and effective methods of analgesia for women in a pain in order, amongst other reasons, to obtain her maximum cooperation. Aim of the Work The aim of this study is to evaluate the efficacy and adverse effects of oral paracetamol (500mg) during the active phase of labor compared with oral solpadeine (paracetamol 500mg with codeine 8mg) as a method for intrapartum analgesia. Patients and Methods This study double blinded randomized controlled trial was conducted on 220 low-risk gravid women have labor pain in first stage of labor and need analgesia comparing the effect of administration of oral paracetamol (500mg) and oral paracetamol 500mg with codeine (8mg) (solpadeine capsule) on managing of pain during active phase of labor. Study setting: The current study was conducted at Ain Shams University Maternity Hospital for about 6 months from February to August 2017. Results As recorded by the VAS score, there was significant pain reduction at 1, 2, 3 and 4 hours in both groups (P = 0.001). The reduction in pain was significantly greater in the solpadeine group only at hour 2 (P = 0.001). Maternal complication as nausea, vomiting, abdominal pain and indigestion were 2 fold to 4 fold more in solpadeine group than in paracetamol group. Conclusion The use of oral paracetamol as analgesia during labor appeared to be effective, safe, done anywhere of labor situations, with no fetal or maternal adverse effects. Using paracetamol as labor analgesia is a new line; it needs to have more chance in comparison with other forms and routs. Also it can be used as adjuvant drug with other types of analgesics. Recommendations Paracetamol may be a good alternative to codeine and opioids as regards analgesic in labor. Maternal and neonatal adverse effects of codeine and opioids as pethidine are good reasons to find another alternative, further randomized controlled trial on wider scale are needed and other forms of paracetamol as suppositories or intravenous are desired to be used as analgesia in different stages of labor and postpartum.