Childbirth Pain? Spray It

Nasal spray of fentanyl effective in relieving labor pain


Birth is a normal process, but it does involve a painful period of labor. A new treatment for the pain may soon become available in Australian hospitals.

A study from the Flinders University and the University of Adelaide found a nasal spray of fentanyl (brand name Duragesic), a pain medication often used in surgery, was just as effective as the traditional medication pethidine (brand name Demerol). Fentanyl also had fewer side effects.

Lead researcher Julie Fleet, PhD, commented in an interview for The Guardian, “Women can self-administer a controlled dose using the nasal spray, under a midwife’s supervision, which helps them feel more in control of their pain management and avoids the need for additional intervention and painful injections.”

Dr. Fleet is a midwife and lectures in midwifery at the University of South Australia.

Dr. Fleet and colleagues studied 156 women during labor, dividing them into three groups.

Women received fentanyl by injection through an epidural catheter or by nasal spray, or received pethidine by injection.

The researchers found women who used fentanyl had a shorter period of labor with less nausea and sedation. They also reported fewer breastfeeding problems and greater satisfaction with pain management.

Babies from mothers treated with fentanyl were less likely to be admitted to the newborn nursery -- a sign of actual or potential complications.

“Fentanyl administered by the nasal spray doesn’t completely eliminate pain – as it can when administered as an epidural, which blocks all sensation – so it is suited to women who still want to be able to feel something,” Dr. Fleet told The Guardian. “It’s also good for women who might not be able to have an epidural due to conditions such as pre-eclampsia.”

When a woman receives medications, they can also affect the baby.

Although pethidine and fentanyl are both opioid medications, they are processed differently by the mother's body. Fentanyl is excreted within a few hours, while pethidine is converted to another substance that remains in both the mother's and baby’s bodies for several days.

In the baby, pethidine can cause breathing trouble, drowsiness and irritability.

“Because fentanyl is not converted in the same way and is out of the system within two to seven hours, it has less chance of producing negative effects on the baby,” Dr. Fleet noted.

The study was published in the January 2015 British Journal of Obstetrics and Gynaecology.

Information on funding and conflict of interest was not available.