25. (3.) Results by individual review ‐ non‐opioid drugs.
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3. Non‐opioid drugs for pain management in labour, 18 studies, 2733 women (Othman 2012) | |||
| 3.1. Non‐opioid drugs versus placebo or no treatment (14 studies, 2003 women) | Outcome | No. of studies (no. women) | Results |
| Sedatives | Pain intensity – 10 cm VAS at one hour | 1 (50) | MD ‐22.00, 95% CI ‐35.86 to ‐8.14, pain scores significantly lower in the non‐opioid group |
| Anti‐spasmodics | Pain intensity – women reporting severe pain during first stage of labour | 1 (84) | RR 0.88, 95% CI 0.72 to 1.08, no evidence of a significant difference |
| Sedatives | Satisfaction with pain relief | 2 (204) | RR 1.59, 95% CI 1.15 to 2.21, women in the non‐opioid group were more likely to express satisfaction with pain relief |
| Anti‐histamines | Satisfaction with pain relief | 1 (223) | RR 1.80, 95% CI 1.16 to 2.79, 1 trial, women in the non‐opioid group were more likely to express satisfaction with pain relief |
| Sense of control | Outcome not reported | ||
| Sedatives | Satisfaction with childbirth experience | 1 (40) | RR 2.16, 95% CI 1.34 to 3.47, women in the non‐opioid group were more likely to express satisfaction with the childbirth experience |
| Effect (negative) on mother/baby interaction | Outcome not reported | ||
| Sedatives | Breastfeeding (no definition of what was meant by breastfeeding provided in the study) | 1 (198) | RR 0.65, 95% CI 0.36 to 1.17, no evidence of a significant difference |
| Anti‐spasmodics | Assisted vaginal birth | 1 (84) | RR 0.45, 95% CI 0.09 to 2.35, no evidence of a significant difference |
| Sedatives | Assisted vaginal birth | 3 (417) | RR 0.93, 95% CI 0.84 to 1.03, no evidence of a significant difference |
| Anti‐histamines | Assisted vaginal birth | 1 (49) | RR 3.12, 95% CI 0.13 to 73.04, no evidence of a significant difference |
| Sedatives | Caesarean section | 2 (203) | RR 3.62, 95% CI 0.40 to 32.65, no evidence of a significant difference |
| Anti‐spasmodics | Adverse effects for women (Reported adverse effects included nausea, vomiting, drowsiness, tachycardia, headache, blurred vision, dryness of the mouth, difficulty in micturition, weakness of the legs, hypotension and atonic postpartum haemorrhage) |
1 (84) | RR 7.27, 95% CI 0.95 to 55.61, no evidence of a significant difference |
| Sedatives | Adverse effects for women (Reported adverse effects included nausea, vomiting, drowsiness, tachycardia, headache, blurred vision, dryness of the mouth, difficulty in micturition, weakness of the legs, hypotension and atonic postpartum haemorrhage) |
3 (216) | RR 1.26, 95% CI 0.67 to 2.35, no evidence of a significant difference |
| Sedatives | Adverse effects for infants | 2 (387) | RR 0.85, 95% CI 0.46 to 1.54, no evidence of a significant difference |
| Anti‐histamines | Adverse effects for infants | Outcome not reported | |
| Admission to special care baby unit/neonatal intensive care unit | Outcome not reported | ||
| Sedative‐analgesics | Apgar score less than seven at five minutes | 3 (259) | RR 1.16, 95% CI 0.55 to 2.45, no evidence of a significant difference |
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
| 3.2. Non‐opioid drugs versus different type of non‐opioid drug (2 studies, 562 women) | Outcome | No. of studies (no. women) | Results |
| Pain intensity | Outcome not reported | ||
| Sedatives versus anti‐histamines | Satisfaction with pain relief | 1 (157) | RR 1.52, 95% CI 1.06 to 2.17, women in the sedative‐analgesic group more likely to express satisfaction with pain relief |
| Anti‐histamine versus different anti‐histamine | Satisfaction with pain relief | 1 (289) | RR 1.21, 95% CI 1.02 to 1.43, women in the hydroxyzine + meperidine group were more likely to express satisfaction with pain relief when compared to the promethazine + meperidine group |
| Sense of control in labour | Outcome not reported | ||
| Satisfaction with childbirth experience | Outcome not reported | ||
| Effect (negative) on mother/baby interaction | Outcome not reported | ||
| Breastfeeding | Outcome not reported | ||
| Anti‐histamine versus different anti‐histamine | Assisted vaginal birth | 1 (289) | RR 0.82, 95% CI 0.64 to 1.03, no evidence of a significant difference |
| Caesarean section | Outcome not reported | ||
| Adverse effects for women | Outcome not reported | ||
| Sedatives versus anti‐histamines | Adverse effects for infants | 1 (157) | RR 0.89, 95% CI 0.06, 14.00, no evidence of a significant difference |
| Admission to special care baby unit/neonatal intensive care | Outcome not reported | ||
| Anti‐histamine versus different anti‐histamine | Apgar score less than seven at five minutes | 1 (289) | RR 1.85, 95% CI 0.17 to 20.21, no evidence of a significant difference |
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
| 3.2. Non‐opioid drug versus same non‐opioid drug of a different dose (1 study, 28 women) | Outcome | No. of studies (no. women) | Results |
| Pain intensity | Outcome not reported | ||
| Sedatives | Satisfaction with pain relief | 1 (19) | RR 0.22, 95% CI 0.04 to 1.33, no evidence of a significant difference |
| Sense of control in labour | Outcome not reported | ||
| Satisfaction with childbirth experience | Outcome not reported | ||
| Effect (negative) on mother/baby interaction | Outcome not reported | ||
| Breastfeeding | Outcome not reported | ||
| Assisted vaginal birth | Outcome not reported | ||
| Sedatives | Caesarean section | 1 (19) | RR 6.00, 95% CI 0.28 to 129.16, no evidence of a significant difference |
| Sedatives | Adverse effects for women (hypotension, blood loss, headache, nausea, vomiting, difficulty in micturition and weakness of the legs). |
1 (19) | RR 0.72, 95% CI 0.09 to 5.59, no evidence of a significant difference |
| Adverse effects for infants | Outcome not reported | ||
| Admission to special care baby unit/neonatal intensive care unit | Outcome not reported | ||
| Apgar score less than seven at five minutes | Outcome not reported | ||
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
| 3.3. Non‐opioid drugs versus a different intervention (opioids) (3 studies, 563 women) | Outcome | No. of studies (no. women) | Results |
| Pain intensity | Outcome not reported | ||
| Non‐steroidal anti‐inflammatory drugs (NSAIDs) |
Satisfaction with pain relief | 1 (76); 1 (77) (same trial, different dose of opioids – 3 arm trial) | RR 0.50, 95% CI 0.27 to 0.94; RR 0.44, 95% CI 0.24 to 0.81, women in the non‐opioid group less likely to express satisfaction with pain relief when compared to the opioid group, irrespective of dose of opioids |
| Anti‐histamines | Satisfaction with pain relief | 1 (223) | RR 0.73, 95% CI 0.54 to 0.98, women in the non‐opioid group less likely to express satisfaction with pain relief when compared to the opioid group |
| Sense of control in labour | Outcome not reported | ||
| Satisfaction with childbirth experience | Outcome not reported | ||
| Effect (negative) on mother/baby interaction | Outcome not reported | ||
| Breastfeeding | Outcome not reported | ||
| Anti‐histamines | Assisted vaginal birth | 1 (48) | RR 1.00, 95% CI 0.07 to 15.08, no evidence of a significant difference |
| Caesarean section | Outcome not reported | ||
| NSAIDs | Adverse effects for women (nausea and vomiting) | 1 (76); 1 (77) (same trial, different dose of opioids – 3 arm trial) | RR 0.64, 95% CI 0.33 to 1.26; RR 0.54 95% CI 0.29 to 1.03, no evidence of a significant difference, irrespective of dose of opioids |
| Adverse effects for infants | Outcome not reported | ||
| Admission to special care baby unit/neonatal intensive care unit | Outcome not reported | ||
| Apgar score less than seven at five minutes | Outcome not reported | ||
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
I2 values reported in table only when random effects analysis has been carried out due to substantial heterogeneity indicated by an I2 value greater than 30% CI: confidence interval; MD: mean difference; RR: risk ratio