title: Diamorphine for pain relief in labour : a randomised controlled trial comparing intramuscular injection and patient-controlled analgesia.
abstract: OBJECTIVE
  To compare the efficacy of diamorphine administered by a patient-controlled pump (patient-controlled analgesia) with intramuscular administration for pain relief in labour.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  The South Glasgow University Hospitals NHS Trust.
  
  
  METHODS
  Primigravidae and multigravidae in labour at term (37-42 weeks).
  
  
  METHODS
  Women were randomised in labour to the study (patient-controlled analgesia) or control group (intramuscular). Randomisation was achieved through a random permuted block design stratified by parity. Study group women were given a loading dose of 1.2 mg diamorphine intravenously and then attached to the pump. Control group women received intramuscular diamorphine as per hospital protocol. Participants were also given 3 mg of buccal Stemetil. Data were collected throughout labour and at six postnatal weeks.
  
  
  METHODS
  Analgesia requirements during labour and women's satisfaction with the method of pain relief.
  
  
  RESULTS
  Women in the study group (patient-controlled analgesia) used significantly less diamorphine than women in the control group (intramuscular) but were significantly more likely to state that they were very dissatisfied with their use of diamorphine and were significantly more likely to opt out of the trial before the birth of the baby. The majority of women in both groups used other analgesia concurrent with diamorphine such as Entonox, aromatherapy or TENS.
  
  
  CONCLUSIONS
  Patient-controlled analgesia administration of diamorphine for the relief of pain in labour offers no significant advantages over intramuscular administration. The results also suggest that diamorphine is a poor analgesic for labour pain irrespective of the mode of administration.
authors.affiliation: School of Nursing and Midwifery, University of Glasgow, UK.
authors.forename: Rhona J
authors.initials: RJ
authors.lastname: McInnes
authors.forename: Edith
authors.initials: E
authors.lastname: Hillan
authors.forename: Diana
authors.initials: D
authors.lastname: Clark
authors.forename: Harper
authors.initials: H
authors.lastname: Gilmour
mesh_terms: D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid; D005260:Female; D020073:Gravidity; D003932:Heroin; D006801:Humans; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010146:Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin