A comparison of fentanyl with pethidine for pain relief during childbirth: A randomised controlled trial

J. Fleet, I. Belan, M. J. Jones, S. Ullah, A. M. Cyna

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)


Objective To compare the efficacy of fentanyl administered via the subcutaneous (s.c.) or intranasal (i.n.) route with intramuscular (i.m.) pethidine in labouring women requesting analgesia. Design A randomised controlled trial three-armed, parallel-design. Setting A regional hospital and the largest tertiary maternity centre in South Australia. Sample One hundred and fifty-six healthy parturients birthing at term. Methods Women were randomised to receive s.c. fentanyl (n = 53), i.n. fentanyl (n = 52), or i.m. pethidine (n = 51). The outcomes were analysed by intention-to-treat. Main outcome measures Pain scores measured before and 30 minutes after opioid administration. Results All groups reported clinically significant reductions in pain scores (mean range 1.2-1.6; P < 0.001), with no significant differences between groups. Significantly more women in the fentanyl groups reported satisfaction with using the study drug again, compared with women receiving i.m. pethidine (82.9% i.n. fentanyl, 80.6% s.c. fentanyl, and 44.0% i.m. pethidine; P < 0.01). Women in the fentanyl groups experienced less sedation (i.n. fentanyl 7.3%, s.c. fentanyl 2.9%, i.m. pethidine 44%; P ≤ 0.03), shorter labours by at least 2 hours (P < 0.05), and fewer difficulties establishing breastfeeding (78.8% i.m. pethidine, 39.4% i.n. fentanyl, and 44.0% s.c. fentanyl; P < 0.01). Neonates in the pethidine group were more likely to require nursery admission (P < 0.02). Conclusions Fentanyl administered by s.c. and i.n. routes is as efficacious in relieving labour pain as i.m. pethidine, but resulted in greater satisfaction, less sedation, shorter labour, fewer nursery admissions, and fewer difficulties in establishing breastfeeding. Fentanyl appears to be a suitable alternative to pethidine when providing parenteral pain relief to labouring women.

Original languageEnglish
Pages (from-to)983-992
Number of pages10
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number7
Publication statusPublished or Issued - 1 Jun 2015
Externally publishedYes


  • Fentanyl
  • intramuscular
  • intranasal
  • labour
  • pethidine
  • subcutaneous

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this