Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Department of Obstetrics and Gynecology, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran

2 Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran


Background & Objective: Labor pain is one of the most severe pains that a woman may experience, so it is important to research the methods to reduce this pain. Paracetamol infusion is an efficient and available remedy to alleviate labor pain in an active phase. This study was conducted to assess the efficacy of intravenous paracetamol injection on reducing labor pain.
Materials & Methods: In this double-blind randomized clinical trial study, the number of 110 nulliparous pregnant women who were candidates for vaginal delivery were included in the study. After the onset of the active phase of labor, the control group received only 300 cc normal saline and the intervention group received 300 cc normal saline plus one gram of paracetamol. The maternal pain score, duration of the first and second stages of labor, delivery type and Apgar score were compared between two groups. Repeated measure ANOVA was used for comparison of means of the VAS score between groups based on repeated observations.
Results: The mean age of the patients was 25.09 ± 4.2 years (18-35 years). The mean length of the first stage (2.85 vs. 3.52 hours, P = 0.001) and second stage (38.77 vs. 43.44 minutes, P = 037) in the intervention group was significantly lower than the control group. Moreover, the mean score of pain was significantly lower in the paracetamol group at all times than the control group (P <0.05).
Conclusion: The prescription of intravenous paracetamol not only reduces pain during labor in women but also reduces the duration of different stages of labor, increases patients’ satisfaction with natural childbirth, and reduces the demand for Cesarean.


Main Subjects

1. Perry SE, Hockenberry MJ, Lowdermilk DL, Wilson D, Alden KR, Cashion MC. Maternal child nursing care-E-Book. 5 ed: Saunders; 2017.
2. Geranmae M, Rezaeepoor A, Haghani H, Akhondzadeh E. Effect education on ration apply methods of nonpharmacologoc for reduction labor pain. Hayat. 2006;2(12):13-21.
3. Roberts L, Gulliver B, Fisher J, Cloyes KG. The coping with labor algorithm: an alternate pain assessment tool for the laboring woman. J Midwifery Womens Health. 2010;55(2):107-16. [DOI:10.1016/j.jmwh.2009.11.002] [PMID]
4. Ranjbaran M, Khorsandi M, Matourypour P, Shamsi M. Effect of massage therapy on labor pain reduction in primiparous women: A systematic review and meta-analysis of randomized controlled clinical trials in Iran. Iran J Nurs Midwifery Res. 2017;22(4):257. [DOI:10.4103/ijnmr.IJNMR_109_16] [PMID] [PMCID]
5. Sh TZ, Honarjoo M, Sh J, Alavi H. The effect of massage on intensity of pain during first stage of labor. Res Med. 2008;32(2):141-5.
6. Payandeh M, Nahidi F, Nasiri M, Fouladi A. Comparing the effects of transcutaneous electrical nerve stimulation and pharmaceutical hyoscine-promethazine compound on duration of second phase of labor. Iran J Obstet Gynecol Infertil. 2019;22(8):19-25. [DOI:10.34172/mj.2019.042]
7. Ohel I, Walfisch A, Shitenberg D, Sheiner E, Hallak M. A rise in pain threshold during labor: a prospective clinical trial. Pain. 2007;132:S104-S8. [DOI:10.1016/j.pain.2007.05.007] [PMID]
8. Mirzaiinajmabadi K, Makvandi S, Mirteimoori M, Sadeghi R. An update on the effect of massage and inhalation aromatherapy with lavender on labor pain relief: A systematic review and meta-analysis. J Obstet Gynecol Cancer Res. 2018;3(1):29-37. [DOI:10.21859/joqcr.3.1.29]
9. Karimi L, Mahdavian M, Makvandi S. A systematic review and meta-analysis of the effect of acupressure on relieving the labor pain. Iran J Nurs Midwifery Res. 2020;25(6):455. [DOI:10.4103/ijnmr.IJNMR_257_19] [PMID] [PMCID]
10. Goda AA, Aboushady RMN, Soliman HFA. Effect of Two Different Nursing Techniques on Labor pain, Duration, and Anxiety Level among Primiparous Women. Egypt J Health Care. 2021;12(1):1079-90. [DOI:10.21608/ejhc.2021.171686]
11. Wuytack F, Smith V, Cleary BJ. Oral non‐steroidal anti‐inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Database Syst Rev. 2021;7(7):CD011352. [DOI:10.1002/14651858.CD011352.pub3] [PMID] [PMCID]
12. Bloor M, Paech M. Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation. Anesth Analg. 2013;116(5):1063-75. [DOI:10.1213/ANE.0b013e31828a4b54] [PMID]
13. 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 Gynaecol Obstet. 2012;118(1):7-10. [DOI:10.1016/j.ijgo.2012.01.025] [PMID]
14. Moradi Farsani D, Safari M, Heydari M, Shafa A. Comparison of the preventive effect of ketamine, paracetamol and metoclopramide on postoperative pain intensity in general anesthesia: a double-blind clinical trial. Sci J Kurd Univ Med Sci. 2019;24(3):134-42. [DOI:10.29252/sjku.24.3.134]
15. Gousheh SM, Nesioonpour S. Intravenous paracetamol for postoperative analgesia in laparoscopic cholecystectomy. Anesth Pain Med. 2013;3(1):214. [DOI:10.5812/aapm.9880] [PMID] [PMCID]
16. Schrock SD, Harraway-Smith C. Labor analgesia. Am Fam Physician. 2012;85(5):447-54.
17. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams obstetrics. 24 ed: Mcgraw-hill New York, NY, USA; 2014.
18. Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med. 2003;28(3):172-97. [DOI:10.1097/00115550-200305000-00004] [DOI:10.1053/rapm.2003.50046] [PMID]
19. Goetzl LM. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists Number 36, July 2002. Obstetric analgesia and anesthesia. Obstet Gynecol. 2002;100(1):177-91. [DOI:10.1016/S0029-7844(02)02156-7] [PMID]
20. Åberg G. Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds. Acta pharmacologica et toxicologica. 1972;31(4):273-86. [DOI:10.1111/j.1600-0773.1972.tb00683.x] [PMID]
21. Lasky RE, van Drongelen W. Is sucrose an effective analgesic for newborn babies? The Lancet. 2010;376(9748):1201-3. [DOI:10.1016/S0140-6736(10)61358-X] [PMID]
22. Eisenberger N, Lieberman M. Why it hurts to be left out: The neurocognitive overlap between physical pain and social pain. The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying2005. p. 109-27.
23. Birnbaum HG, White AG, Reynolds JL, Greenberg PE, Zhang M, Vallow S, et al. Estimated costs of prescription opioid analgesic abuse in the United States in 2001: a societal perspective. The Clinical journal of pain. 2006;22(8):667-76. [DOI:10.1097/] [PMID]
24. Harrison D, Stevens B, Bueno M, Yamada J, Adams-Webber T, Beyene J, et al. Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Arch Dis Child. 2010;95(6):406-13. [DOI:10.1136/adc.2009.174227] [PMID]
25. Burkman RT. Williams Obstetrics. JAMA. 2010;304(4):474-5. [DOI:10.1001/jama.2010.1039]