• Sallama Kamel Nasir Department of Gynecology and Obstetrics, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Hala Shaaban Ibrahim Maternity Teaching Hospital, Directory of Health of Sulaimani, Kurdistan Region, Iraq.



Labour pain, Analgesia, Intramuscular pethidine, Intravenous paracetamol



Labour is one of the most painful and stressful events in life. The intensity of pain experienced by women in labour has been found to affect the progress of labour, fetal well-being and maternal psychology. Intramuscular pethidine is one of most common drugs used for labour analgesia. Paracetamol may be used as alternative to pethidine as labour analgesia. 


To compare the efficacy and adverse effects of intravenous paracetamol versus intramuscular pethidine hydrochloride as analgesia in the 1st stage of labour.

Patients and Methods

This is a single-blinded prospective-randomized study conducted in Sulaimani maternity teaching hospital over a period of six months starting from the 1st of December 2017 till 31st of May 2018. The study included 200 primigravidae women with term uncomplicated pregnancy in their active phase of labour. After taking informed consent, the women were randomly distributed into two groups, one hundred women received 1000mg paracetamol by intravenous infusion, and the other one hundred women received 100 mg pethidine intramuscularly. The primary outcome was the efficacy of the drug to provide adequate analgesia in labour. Pain intensity before administering drug was recorded by Mc Gills pain intensity scale, then at the 1sthr, and in the 3rdhr after drug administration. The secondary outcomes included the presence of adverse maternal effects, mode of delivery and fetal Apgar scores at 1st and 5th minutes. 


The mean of pain score was low in both groups after 1h of drug administration but it was significantly lower in the pethidine group. Also at 3h of drug administration the mean pain score was significantly much lower in pethidine group compared to the paracetamol group (p -value=0.001). The maternal and neonatal side effects were significantly higher in the pethidine group compared to the paracetamol group (P value= 0.001)


Intramuscular pethidine is more effective than intravenous paracetamol in relieving pain during the 1st stage of labour. But the use of paracetamol causes less maternal and neonatal side effects than pethidine.


Felicity Plaat, Analgesia, Anesthesia and Resuscitation. In: Keith Edmonds, Editor. Dewhurst’s textbook of Obstetrics & Gynecology, 8th Ed. Wiley- Blackwell; 2012. P: 356. DOI:

Lowe NK. The nature of labour pain. American Journal of Obstetrics and Gynecology 2002; 186: 16–24. DOI:

Othman M, Jones L, Neilson JP. Non-opioid drugs for pain management in labour: an overview of systematic reviews. Journal of Evidence-Based Medicine. 2012, May;5 (2):101-2. DOI:

Goetzl LM. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists Number 36, July (2002). Obstetric analgesia and anesthesia. Obstetrics and gynecology. (2002) Jul; 100(1):177-91. DOI:

Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews. 2005, Issue 4. [DOI: 10.1002/ 14651858.CD000331.pub2]. DOI:

Hughes SC, Levinson G, Rosen MA, Shnider SM, editors. Shnider and Levinson's anesthesia for obstetrics. Lippincott Williams & Wilkins; 2002: 92.

Hughes SC, Levinson G, Rosen MA, Shnider SM, editors. Shnider and Levinson's anesthesia for obstetrics. Lippincott Williams & Wilkins; 2002: 94.

Chu A, Ma S, Datta S. Analgesia in labour and delivery. Obstetrics, Gynecology and Reproductive Medicine. 2017 Jun 1; 27(6):184-90. DOI:

Bektas F, Eken C, Karadenz O, Goksu E, Cubuk M, Cete Y. Intravenous paracetamol or morphine for the Treatment of Renal Colic: A Randomized, Placebo-Controlled Trial. Ann Emerg Med 2009; 54: 568–574. DOI:

Singla NK, Parulan C, Samson R, Plasma and cerebrospinal fluid pharmacokinetic parameters after single-dose administration of intravenous, oral, or rectal acetaminophen. Pain Pract. 2012;12(7):523–532 DOI:

Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund LA. Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth. 2005;94(5):642–648 DOI:

Hyllested M, Jones S, Pedersen JL et al. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: A qualitative review. Br J Anaesth 2002 ; 88: 199–214. DOI:

Fox ER, Jones VM, Beckwith MC. Acetaminophen Injection: A Review of Clinical Information Including Forms Not Available in the United States. Journal of pain & palliative care pharmacotherapy. 2012. Jun 22;26(2):115-7. DOI:

Isbister GK, Bucens IK, Whyte IM. Paracetamol overdose in a preterm neonate. Arch Dis Child Fetal Neonatal Ed. 2001; 85: 70– DOI:

Abdollahi MH, Mojibian M, Pishgahi A, Intravenous paracetamol versus intramuscular pethidine in relief of labour pain in primigravid women. Niger Med J 2014;55(1):54–57 DOI:

Melzack R, J. The McGill pain Questionnaire: appraisal and current status. Guilford press; (2001).

Elbohoty AE, Abd-Elrazek H, Abd-El-Gawad M, Salama F, El- Shorbagy M, Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labour. Int J Gynaecol Obstet. 2012; 118:7-10 DOI:

Lallar M, Anam HU, Nandal R, Singh SP, Katyal S. Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labour analgesic. J Obstet Gynaecol India 2015;65(1):17–22 DOI:

Ankumah NA, Tsao M, Hutchinson M, Pedroza C, Mehta J, Sibai BM, et al. Intravenous acetaminophen versus morphine for analgesia in labor: a randomized trial. American journal of perinatology. 2017 Jan;34(01):38-43. DOI:

Khooshideh M, Shahriari A. A comparison of tramadol and pethidine analgesia on the duration of labour: a randomized clinical trial. Australian and New Zealand Journal of Obstetrics and Gynecology. 2009 Feb 1;49(1):59-63. DOI:



How to Cite

Nasir S, Ibrahim H. INTRAVENOUS PARACETAMOL INFUSION VERSUS INTRAMUSCULAR PETHIDINE AS LABOUR ANALGESICS. JSMC [Internet]. 2019 Dec. 21 [cited 2024 Jun. 13];9(4):347-55. Available from:

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