The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Comparison of ‘of Oxygen, N2O and Dexamethasone Mixture’ vs. ‘Remifentanil and Dexamethasone' in Painless Delivery Control: A Randomized Clinical Trial

Document Type : Original Article

Authors
Giti Rahimi 1
Ahmad Ghazi 2
Khatereh Isazadefar 3
Zahra Asdagh 1
1 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
2 Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
3 Associate Professor, Department of Social Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
10.22038/ijogi.2025.82723.6215
Abstract
Introduction: Labor pain is often severe, and unrelieved pain can negatively impact women's physiological status. Accurate measurement and effective management of pain is crucial for medical and nursing staff. Various options for pain relief during labor come with their own risks and benefits. The present study was conducted with aim to compare the efficacy of Entonox and Dexamethasone versus Remifentanil and Dexamethasone in painless delivery control.
Methods: This study was conducted in 2018-2019 on 100 pregnant women (Gravida 1) in the active phase of labor who were selected from the patients visiting Alavi Hospital. Group A received analgesia through inhalation of a mixture of oxygen and N2O (Entonox) along with dexamethasone, while Group B received analgesia through injections of remifentanil and dexamethasone. Pain scores were measured based on the Visual Analog Scale (VAS) before the intervention and at 30, 60, 120, and 180 minutes after the intervention. The data were analyzed using SPSS software (version 25) and independent t and Mann-Whitney tests. P<0.05 was considered significant.
Results: Pain severity was significantly lower in the Remifentanil and Dexamethasone group at 30, 60, 120, and 180 minutes post-intervention compared to the Entonox and Dexamethasone group. No significant differences were observed between the two groups in obstetric indices (p=0.233) and neonatal (p=0.25) complications.
Conclusion: Concomitant use of remifentanil and dexamethasone is recommended compared to Entonox and dexamethasone due to providing more favorable analgesia during labor.
Keywords
Remifentanil
Painless delivery
Dexamethasone
Entonox
Subjects
  1. Leifer G. Maternity nursing: an introductory text. 11nd Philadelphia: Elsevier Health Sciences; 2011.
  2. Kukulu K, Demirok H. Effects of epidural anesthesia on labor progress. Pain Management Nursing 2008; 9(1):10-6.
  3. Murphy DJ, Pope C, Frost J, Liebling RE. Women's views on the impact of operative delivery in the second stage of labour: qualitative interview study. Bmj 2003; 327(7424):1132.
  4. Lowe NK. The nature of labor pain. American journal of obstetrics and gynecology 2002; 186(5):S16-24.
  5. Kim HH, Nava-Ocampo AA, Kim SK, Kim SH, Kim YJ, Han JY, et al. Is prenatal childbirth preparation effective in decreasing adverse maternal and neonatal response to labor? A nested case-control study. Acta Biomedica-Ateneo Parmense 2008; 79(1):18.
  6. Kimber L, McNabb M, Mc Court C, Haines A, Brocklehurst P. Massage or music for pain relief in labour: a pilot randomised placebo controlled trial. European Journal of pain 2008; 12(8):961-9.
  7. Fogarty V. Intradermal sterile water injections for the relief of low back pain in labour—a systematic review of the literature. Women and birth 2008; 21(4):157-63.
  8. Saxena KN, Nischal H, Batra S. Intracutaneous injections of sterile water over the secrum for labour analgesia. Indian journal of anaesthesia 2009; 53(2):169-73.
  9. Jafari Avid M. Painless labor and anesthesia in midwifery. Tehran: Porsina Publications. 2001.
  10. Murray SS, McKinney ES. Foundations of Maternal-Newborn and Women's Health Nursing-E-Book: Foundations of Maternal-Newborn and Women's Health Nursing-E-Book. Elsevier Health Sciences; 2013.
  11. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief. American Family Physician 2003; 68(6):1109-13.
  12. Aram SH, Attary MA. The evaluation and comparison of delivery pain with and without entonox inhalation in labor department of Beheshti Hospital in Isfahan during 1997-98. J Isfahan Univ Med Sci. 1999; 16 (53): 32-27. J Isfahan Univ Med Sci 1999; 16(53):32-27.
  13. Potter PA, Perry AG. Basic Nursing: Essentials for Practice. Mosby; 2003.
  14. Chestnut DH, Wong CA, Tsen LC, Kee WD, Beilin Y, Mhyre J. Chestnut's obstetric anesthesia: principles and practice e-book. Elsevier Health Sciences; 2014.
  15. Roelants F, De Franceschi E, Veyckemans F, Lavand’homme P. Patient-controlled intravenous analgesia using remifentanil in the parturient. Canadian journal of anaesthesia 2001; 48:175-8.
  16. Glass PS, Hardman D, Kamiyama Y, Quill TJ, Marton G, Donn KH, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B). Anesth Analg 1993; 77(5):1031-40.
  17. Volikas I, Male D. A comparison of pethidine and remifentanil patient-controlled analgesia in labour. International journal of obstetric anesthesia 2001; 10(2):86-90.
  18. Scott LJ, Perry CM. Remifentanil: a review of its use during the induction and maintenance of general anaesthesia. Drugs 2005; 65:1793-823.
  19. Balki M, Kasodekar S, Mbbs SD, Bernstein P, Carvalho JC. Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens. Can J Anaesth 2007; 54(8):626-633.
  20. Olufolabi AJ, Booth JV, Wakeling HG, Glass PS, Penning DH, Reynolds JD. A preliminary investigation of remifentanil as a labor analgesic. Anesthesia & Analgesia 2000; 91(3):606-8.
  21. Hajivandi L, Montazeri S, Irvani M, Oliyai A. Investigating the effect of intramuscular dexamethas on duration of labor in post date pregnancy. SSU_Journals 2013; 21(5):555-63.
  22. Kalantaridou S, Makrigiannakis A, Zoumakis E, Chrousos GP. Peripheral corticotropin-releasing hormone is produced in the immune and reproductive systems: actions, potential roles and clinical implications. Frontiers in Bioscience: a Journal and Virtual Library 2007; 12:572-80.
  23. Agah J, Baghani R, Safiabadi Tali SH, Tabarraei Y. Effects of continuous use of Entonox in comparison with intermittent method on obstetric outcomes: a randomized clinical trial. Journal of pregnancy 2014; 2014(1):245907.
  24. Natural childbirth without pain. himama.ir/labour-and-birth
  25. Schnabel A, Hahn N, Broscheit J, Muellenbach RM, Rieger L, Roewer N, et al. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. European Journal of Anaesthesiology| EJA 2012; 29(4):177-85.
  26. Tveit TO, Halvorsen A, Seiler S, Rosland JH. Efficacy and side effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study. International journal of obstetric anesthesia 2013; 22(1):19-25.
  27. Arnal D, Serrano ML, Corral EM, García del Valle S. Intravenous remifentanyl for labor analgesia. Revista Espanola de Anestesiologia y Reanimacion 2009; 56(4):222-31.
  28. Varposhti MR, Ahmadi N, Masoodifar M, Shahshahan Z, Tabatabaie MH. Comparison of remifentanil: Entonox with Entonox alone in labor analgesia. Advanced biomedical research 2013; 2(1):87.
  29. Mohammad Jaafari R, Barati M, Torabzadeh Bafghi VA, Torabzadeh Bafghi AA. The effect of entonox gas inhalation on the duration of active phase of labor and outcome of delivery. Jundishapur scientific medical journal 2013; 12(1):13-9.
  30. Dargahi R, Ghazi A, Hashemi PF, Amani F. A comparative study about the efficacy of Entonox gas analegesia alone and in combination with dexamethasone in painless labor. JAP 2018; 8(2):61-71.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 4
June 2025
Pages 19-28