Analgesia with sevoflurane during labour: II. Sevoflurane compared with Entonox for labour analgesia
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1 Magill Department of Anaesthesia, Imperial College London, Chelsea and Westminster Hospital 369 Fulham Road, London SW10 9NH, UK
2 East Surrey Hospital Canada Avenue, Redhill, Surrey RH1 5HR, UK
3 Independent Statistician Ruislip HA4 7YU, UK
4 Present address: Hereford Hospitals NHS Trusts Hereford HR1 2ER, UK
*Corresponding author: Anaesthetic Department, The County Hospital, Union Walk, Hereford HR1 2ER, UK. E-mail: sengyeo{at}hotmail.com
Background. We determined the optimal inspired sevoflurane concentration for use during labour as 0.8% in our previous study. This study compared sevoflurane at a concentration of 0.8% and Entonox® (nitrous oxide 50%: oxygen 50%) for analgesia during labour in 32 healthy parturients.
Methods. Each mother underwent two open-label, three-part sequences in random order, Entonox-sevoflurane-Entonox or sevoflurane-Entonox-sevoflurane. In each part the agent was self-administered during 10 contractions. A 100 mm visual analogue scores for pain relief and sedation was completed immediately after each contraction.
Results. Two patients withdrew during administration of sevoflurane (because of its odour) and five during Entonox (requesting epidural analgesia). Of the remaining women, data were available for analysis from 29 participants: median (IQR [range]) pain relief scores were significantly higher for sevoflurane 67 (55–74 [33–100]) mm than for Entonox 51 (40–69.5 [13–100]) mm (P<0.037). Nausea and vomiting were more common in the Entonox group [relative risk 2.7 (95% CI 1.3–5.7); P=0.004]. No other adverse effects were observed in the mothers or babies. There was significantly more sedation with sevoflurane than with Entonox {74 (66.5–81 [32.5–100]) and 51 (41–69.5 [13–100]) mm, respectively; P<0.001}. Twenty-nine patients preferred sevoflurane to Entonox and found its sedative effects helpful.
Conclusions. We conclude that self-administered sevoflurane at subanaesthetic concentration (0.8%) can provide useful pain relief during the first stage of labour, and to a greater extent than Entonox. Although greater sedative effects were experienced with sevoflurane, it was preferred to Entonox.
This research was presented at the Obstetric Anaesthetist's Association Annual Meeting 2004 and published as the following abstract: ‘Sevoflurane vs Entonox during labour contractions’.
This article is accompanied by Editorial I.
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