A few days ago we talked about epidural analgesia based on the typical phrase of many of those who defend it: "If you don't get a tooth without anesthesia, why do you want to give birth without epidural?" The case is that, as we commented, although the ideal to avoid an instrumentalized delivery is the birth without epidural, there are women who prefer to use it.
But epidural analgesia is not the only way to alleviate the pain of childbirth and In Australia, nasal spray analgesia is beginning to be used, a type of analgesia somewhat less effective but much less invasive, which allows to continue feeling much of the process of childbirth with less pain. Is it goodbye to the epidural?
The arrival of fentanyl nasal spray
He fentanyl It is an opioid medication that is not new in the world of obstetrics because it has been tested as an intravenously administered analgesic for years. It is considered effective for birth control, although its safety in infants has not yet been clearly established, since in some studies it seems to affect the Apgar at birth test when compared to other types of analgesics.
However, the nasal presentation seems safer and is being used even for pain in children and patients who are transferred by ambulance.
This is at least what emerges from a study with 156 women conducted at the University of Flinders and the University of Adelaide, in Australia, in which the use of fentanyl spray as an alternative method for pain control in childbirth. The work has been led by Julie Fleet, who talks about it in The Guardian:
Women can self-administer a controlled dose of the nasal spray under the supervision of a midwife, which helps them feel greater control in pain management and avoids the need for additional intervention and painful injections.
Results of the study
In this study, which Fleet has used as a basis for his thesis, the use of subcutaneous fentanyl (less invasive than intravenous), spray fentanyl and intramuscular pethidine was compared, which is one of the methods most commonly used in women who They want some analgesia without using the epidural.
In all three groups of women it was achieved a significant reduction in pain 30 minutes after administration, without the difference being significant. When asking women if they would use the analgesia used next time, 82.9% of those who used the spray said they would, for 80.6% of the subcutaneous fentanyl group and 44 % of those in the intramuscular pethidine group.
In addition, women with fentanyl explained that they felt less sedated within 30 minutes of receiving the dose, with labor for up to two hours less. There were no differences in the Apgar test but there were more babies from the pethidine group that needed to go to the nursery. Women in the pethidine group also reported more problems establishing breastfeeding in the first 6 weeks after delivery.
Again, in Fleet's words:
The fentanyl administered by nasal spray does not completely eliminate pain, as it is achieved when the epidural is administered, which blocks all sensation, so it is suitable for women who still want to be able to feel something.
The reason for that data is that pethidine remains in the baby for three or more days, may cause breathing problems, drowsiness and irritability. Fentanyl, on the other hand, is eliminated in the first two to seven hours, with less probability of producing negative effects on the baby.
And what is better then, the nasal spray or the epidural?
The study has only compared external pain control methods, that is, without the introduction of analgesia in the medullary canal, so although they have the same purpose, to alleviate the pain, the mechanism is different and it will not be until a while when Let us know to what extent the aerosol can unseat the epidural.
Fleet also commented that they are studying now, thanks to the inclusion of the drug in hospitals, the differences between the epidural and the spray, although it underlines what has already been said: with the spray the pain is not completely controlled, but leaves much more freedom than the epidural and the possible risks of its administration are eliminated.
So, we look forward to knowing more about this promising nasal spray because it may be an alternative to consider for some women who may want to avoid epidurals but at some point feel that the pain is too much.
Photos | Juanedc, Martijn Dehing on Flickr
In Babies and more | What type of delivery would you feel most satisfied with? Birth without epidural, an option for all pregnant women ?, Birth without epidural, does it hurt a lot?
