Paracetamol versus meperidine for relief of labour pain in primiparous women: a randomized controlled trial

Sherif M. Habib, Mohamed H. Mostafa, Mohamed H. Salama, Hend G. Swilam


Background: Most parturient women request analgesia, of which, there are two types; opioids and non-opioids. Opioids include morphine and meperidine, while non-opioids, which are milder forms of painkillers, include acetaminophen (paracetamol) and non-steroid anti-inflammatory drugs. The major concerns associated with opioids are the risk of neonatal respiratory depression, the cost and availability.

Methods: The aim of this study was to compare the efficacy and safety of paracetamol versus meperidine for intra-partum pain relief. A total of 92 primiparous singleton term pregnant women were randomly allocated to receive intravenous paracetamol (1000 mg), or intramuscular meperidine (50 mg), at the beginning of the active phase of labor. The primary outcome was the labor pain perception, assessed using the visual analogue scale (VAS), at baseline, 15, 30, 60 and 120 minutes after administration of the drug.

Results: Women of both groups showed significant reduction of the VAS after administration of the medication. There were no differences between both groups regarding the mode of delivery and the durations of the first or second stages of labor. However, meperidine was associated with higher rates of dizziness and nausea/vomiting. The 1-min Apgar scores were significantly lower in meperidine group. However, there were no differences in the 5-min Apgar score, need for neonatal resuscitation or neonatal respiratory distress.

Conclusions: intravenous paracetamol as analgesia during labor is effective with no fetal or maternal adverse effects. Its use should have more chance for intrapartum pain relief. Additionally, it can be used as adjuvant with other types of analgesics.


Intra-partum anaelgesia, Labour Pain, Meperidine, Paracetamol

Full Text:



Whitburn LY, Jones LE, Davey MA, Small R. The meaning of labour pain: how the social environment and other contextual factors shape women’s experiences. BMC Preg Child. 2017;17(1):157.

Allameh Z, Rouholamin S, Hekmat R. Comparison of vaginal misoprostol tablet with oxytocin infusion for induction of labor in term pregnancy. J Res Med Sci. 2012;17:134-9.

Thurlow JA. Analgesic regimens for parturient women. Int J Obstetric Anesthesia. 2002;131:276-17.

Simkin PP, O’Hara. Non-pharmacologic relief of pain during labour: systemic review of five methods. Am J Obstet Gynecol. 2002;186:s131-59.

Pandya KJ. Epidural anesthesia and other regimens used for relief of normal labour pain. Rochester Medical Center. 2015;585:275.

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

Movahed F, Poorrostamy S. Comparison of indomethethacin supposetory with intramuscular pethidine on the pain after cesarean section. J Qazvin Univ Med Sci. 2003;32:2629.

Chou D, Abalos E, Gyte GM, Gülmezoglu AM. Paracetamol/acetaminophen (single administration) for perineal pain in the early postpartum period. Cochrane Database of Systematic Reviews. 2010(3).

Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesthesia. 2002;88(2):199-214.

Viscomi CM, Rathmell JP, Pace NL. Duration of intrathecal labor analgesia: early versus advanced labor. Anesthesia Analgesia. 1997;84(5):1108-12.

Alhashemi JA, Tawfeeq NA, Sadat M, Mujallid RH. Intravenous acetaminophen versus intramuscular meperidine for labor analgesis. Am Society of Anesthesiologists Annual Meeting Abstracts. Chicago, IL: American Society of Anesthesiologists. 2011.

Othman M, Jones L, Neilson JP. Non‐opioid drugs for pain management in labour. Cochrane Database of Systematic Reviews. 2012(7). Available at:

El-Kerdawy H, Farouk A. Labor analgesia in preeclampsia: remifentanil patient controlled intravenous analgesia versus epidural analgesia. Middle East J Anaesthesiol. 2010;20(4):539-45.

Abd‐El‐Maeboud KH, Elbohoty AE, Mohammed WE, Elgamel HM, Ali WA. Intravenous infusion of paracetamol for intrapartum analgesia. J Obstet Gynaecol Res. 2014;40(11):2152-7.

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. Am J Perinatol. 2017;34(1):38-43.

Molloy A. Does pethidine still have a place in therapy?. Australian Prescriber. 2002;25(1):79-80.

Makkar JK, Jain K, Bhatia N, Jain V, Mithrawal SM. Comparison of analgesic efficacy of paracetamol and tramadol for pain relief in active labor. Journal of clinical anesthesia. 2015;27(2):159-63.

Anderson D. A review of systemic opioids commonly used for labor pain relief. J Midwifery Women? Health. 2011;56(3):222-39.