Dear All
We are currently offering a PhD studentship to try to unpack some of this. I
agree that it is likely that all opiates do come with side effects but if a
woman is requesting IM analgesia then I think we need to know which is best.
A small study (Fairlie et al 1999) comparing IM pethidine with diamorphine
showed diamorphine to have some benefits over pethidine but did not address
the potential adverse effects of either. [Fairlie FM, Marshall L, Walker JJ,
Elbourne D Intramuscular opoid for maternal pain relief in labour: a
randomised controlled trial comparing pethidine with diamorphine. Br I
Obstetric Gynaecology 1999; 106: 1181-7
The details of our studentship are as follows (applications are being
considered on Thurs 27.4.06):
For women requesting IM pain relief during labour which is best- pethidine
or diamorphine?
Professor Peter Thomas, Dr Mike Wee (Poole Hospital), Professor Jo Alexander
If women in labour in the UK request intra-muscular pain relief, pethidine
is frequently given. However, there are a number of concerns regarding how
effective it is, and whether it is harmful to mother and baby. Diamorphine
may be a better option. The student will undertake a two-centre randomised
controlled trial comparing the effectiveness of intramuscular diamorphine
and pethidine, and conduct interviews with a small number of women to
explore their experiences of using each. This study is likely to have a
significant impact on midwifery and anaesthetic practice.
Three full-time PhD studentships (fees included) connected with the WOMB
Programmatic Research Group [WOMen, Babies and their families] of IHCS,
Bournemouth University have been announced on the website:
www.bournemouth.ac.uk/thegraduateschool/phd_studentships/phd_studentships.html
For general information about the studentships and research degrees at
Bournemouth University contact:
[log in to unmask]
Enquiries about specific studentships outlined above should be directed to:
[log in to unmask]
Best wishes to all
Jo
----- Original Message -----
From: "Denis Walsh" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, April 12, 2006 6:51 AM
Subject: Re: Opiate of Choice
> Hi James,
> My impression having talked to midwives in many different units across
> England and Scotland is that Pethidine is still by far the most commonly
> used opiate, especially in England. Not so in Scotland where Diamorphine
> is favoured generally. Some places also use Meptid. My understanding of
> the Cochrane reviews are that the other opiates have no particular
> advantage over Pethidine, though those who use Diamorphine say it gives
> more effective analgesia. I agree with Belinda - none are much good and
> all come laden with side effects.
> Denis Walsh
> ----- Original Message -----
> From: "Belinda Cox" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, April 11, 2006 9:30 PM
> Subject: Re: Opiate of Choice
>
>
>> Hi James,
>>
>> I believe there's a study going on at the moment looking at which is more
>> effective.
>>
>> You certainly aren't one of the last UK Trust to do this. Anecdotally, I
>> think that the use of diamorphine is more common in the north, and less
>> so in the South. I'm not aware of any of the local Trusts in the South
>> West using diamorphine (although that doesn't mean there aren't any!).
>> When I worked in Glasgow between 1996 and 2000 diamorphone was the opiate
>> of choice there.
>>
>> There was a national shortage of diamorphine last year, not sure whether
>> that's improved yet.
>>
>> Personally I'm rather sceptical about the use of opiates in labour at
>> all.
>>
>> Best wishes,
>>
>> Belinda
>>
>>
>> ----- Original Message -----
>> From: "James Harris" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Tuesday, April 11, 2006 7:48 PM
>> Subject: Opiate of Choice
>>
>>
>>> Hello everyone.
>>>
>>> My trust is currently looking at changing the Opiate that is given in
>>> labour
>>> from Pethidine to Diamorphine; as we seem to be one of the last UK
>>> trusts to
>>> do this, I was wondering if anyone could give any advice on how to
>>> instigate
>>> the change?
>>>
>>> Is there any research regarding the benefits of one over the other?
>>> Has anyone regretted the change?
>>> Was there any resistance, from staff or pharmacy?
>>> Has there been any supply problems?
>>>
>>> Many thanks for your help, and wishing everyone a happy Easter and
>>> Passover.
>>>
>>> Regards
>>>
>>> James Harris
>>> Midwife
>>>
>>
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