Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine


Correspondence: Dr F. Fairlie, The Jessop Hospital, Leavygreave Rd, Sheffield S3 7RE, UK.


Objective To compare the pain relief and side effects of intramuscular pethidine with intramuscular diamorphine in labour.

Design Double-blind randomised controlled trial.

Setting The labour ward in a UK teaching hospital.

Participants Sixty-nine nulliparous women and 64 multiparous women in labour who requested narcotic analgesia and remained undelivered one hour after trial entry.

Methods Nulliparous women were randomised to receive either 150 mg intramuscular pethidine or 7–5 mg intramuscular diamorphine. Multiparous women were randomised to receive either 100 mg intramuscular pethidine or 5 mg intramuscular diamorphine. All participants received the anti-emetic prochloroperazine at the same time as the trial drugs.

Main outcome measures Maternal analgesia assessed by a visual analogue score and verbal scales of pain intensity and pain relief, maternal sedation and vomiting, neonatal outcome assessed by Apgar scores and the need for resuscitation.

Results More women allocated to receiving pethidine than to diamorphine reported slight or no pain relief at 60 minutes after administration of these drugs (P= 0.03). This trend was repeated in most of the other measures for maternal analgesia. There was no difference in maternal sedation, but the incidence of vomiting within 60 minutes was lower for women who received diamorphine (P= 0.02). Pethidine was associated with lower Apgar scores at 1 minute (P < 0.05).

Conclusion Intramuscular diamorphine in labour appears to have some benefits, compared with intramuscular pethidine, but the trial was small and further research, particularly into alternative opioids and long term effects on the infants is still needed.