Intravenous meperidine during labor: a randomized comparison between nursing- and patient-controlled administration

Preliminary reports about patient-controlled analgesia during labor have been promising. The purpose of this investigation was to compare our experience with meperidine given intravenously by the patient versus by a nurse. Sixty-four healthy women beginning active labor (cervical dilation 3 cm) at term were randomly assigned to either self-administer a 10-mg dose as often as every 20 minutes or have a nurse administer 25-50 mg every 3 hours as requested. The total meperidine dose and consumption rates were greater when administered by the patient than by a nurse. Maternal side effects occurred with similar frequency in both groups, and pain relief was judged to be equivalent. Maternal and umbilical serum concentrations of meperidine at delivery increased in the patient-controlled group if active labor lasted longer than 2 hours. Neonatal naloxone therapy was used more often when meperidine was administered by the patient than by a nurse (five of 31, 16%, versus three of 33, 10%, respectively). Self-administration of intravenous meperidine by the laboring patient was not found to be advantageous over nursing administration, and may pose an increased threat to the infant.