Effects of Intradermal Sterile Water Injections in Women with Low Back Pain in Labor: A Randomized, Controlled, Clinical Trial

Abstract

Background: In addition to the pain caused byuterine contractions during labour, continuous and severe back pain is observed in 33% of women. Several pharmacological and nonpharmacological methods are available for managing this pain. Sterile water injection is considered as alternative method for nonpharmacological pain management. Aims: To assess the satisfaction level and effectiveness of sterile water injection for back pain among women in labour. Study Design: Randomized controlled trial. Methods: A total of 168 term, healthy women with labour pain and severe back pain were randomized into the sterile water injection (study) and dry injection (placebo) groups. Injections were applied to the rhombus of Michaelis in the sacral area. Pain scores were assessed at 10, 30, 60, 120, and 180 min using a visual analogue scale. Additionally, the need for epidural analgesia, Apgar score, mode of delivery, time of delivery, maternal satisfaction, and breastfeeding score were assessed. Results: The mean back pain scores at 30 min after injections were significantly lower in the study group (study group: 31.66±11.38; placebo: 75±18.26, p

Keywords

• Analgesia, injections, labor, obstetrical, pain, randomized controlled trial

Kaynakça

1. 1. Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief. Am Fam Physician 2003;68:1109- 12.
2. 2. Melzack R, Schaffelberg D. Low-back pain during labor. Am J Obstet Gynecol 1987;156:901-5.
3. 3. Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002;186(5 Suppl Nature):160-72.
4. 4. Bengtsson J, Worning AM, Gertz J, Struckmann J, Bonnesen T, Palludan H, et al. Pain due to urolithiasis treated by intracutaneous injection of sterile water. A clinically controlled double-blind study. Ugeskr Laeger 1981;143:3463-5.
5. 5. Byrn C, Olsson I, Falkheden L, Lindh M, Hösterey U, Fogelberg, et al. Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries. Lancet 1993;341:449-52.
6. 6. Lytzen T, Cederberg L, Möller-Nielsen J. Relief of low back pain in labor by using intracutaneous nerve stimulation (INS) with sterile water papules. Acta Obstet Gynecol Scand 1989;68:341-3.
7. 7. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev 2012:CD009234.
8. 8. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: Twenty-year update. Anesthesiology 2005;103:645-53.

9. 9. Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2012;10:CD003401.
10. 10. Ader L, Hansson B, Wallin G. Parturition pain treated by intracutaneous injections of sterile water. Pain 1990;41:133-8.
11. 11. Bahasadri S, Ahmadi-Abhari S, Dehghani-Nik M, Habibi GR. Subcutaneous sterile water injection for labour pain: a randomised controlled trial. Aust N Z J Obstet Gynaecol 2006;46:102-6.
12. 12. Kushtagi P, Bhanu BT. Effectiveness of subcutaneous injection of sterile water to the lower back for pain relief in labor. Acta Obstet Gynecol Scand 2009;88:231-3.
13. 13. Mårtensson L, Wallin G. Labour pain treated with cutaneous injections of sterile water: a randomised controlled trial. Br J Obstet Gynaecol 1999;106:633-7.
14. 14. Trolle B, Moller M, Kronborg H, Thomsen S. The effect of sterile water blocks on low back labor pain. Am J Obstet Gynecol 1991;164:1277-81.
15. 15. Wiruchpongsanon P. Relief of low back labor pain by using intracutaneous injections of sterile water: a randomized clinical trial. J Med Assoc Thai 2006;89:571-6.
16. 16. Labrecque M, Nouwen A, Bergeron M, Rancourt JF. A randomised controlled trial of nonpharmacologic approaches for relief of lower back pain during labor. J Fam Pract 1999;48:259-63.
17. 17. Mårtensson L, Stener-Victorin E, Wallin G. Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain. Acta Obstet Gynecol Scand 2008;87:171-7
18. 18. Fogarty V. Intradermal sterile water injections for the relief of low back pain in labour-a systematic review of the literature. Women Birth 2008;21:157-63.
19. 19. Mårtensson L, Wallin G. Sterile water injections as treatment for low-back pain during labour: A review. Aust N Z J Obstet Gynaecol 2008;48:369-74.
20. 20. OECD (2016), Caesarean sections (indicator). (Accessed on 06 June 2016)
21. 21. Lee N, Mårtensson LB, Homer C, Webster J, Gibbons K, Stapleton H, et al. Impact on caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial. BMC Pregnancy Childbirth 2013;13:105.
22. 22. Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesth 2010;105(Suppl 1):50-60.