Taking the alternative route: Women's experience of intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia

© 2017 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Objective To compare women’s experience of receiving either intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia. Design A content analysis was undertaken as part of the third phase of a larger randomised controlled trial, using the per-protocol dataset to examine women’s experiences of treatment received. Healthy women birthing at term, who received intranasal fentanyl (n=41), subcutaneous fentanyl (n=37) and/or intramuscular pethidine (n=38) for labour analgesia, were contacted at 6 weeks postpartum to complete a phone questionnaire. Setting A tertiary and regional maternity unit in South Australia. Findings Over 80% of women who received intranasal or subcutaneous fentanyl reported that they would use the treatment again compared to 44.8% of women who had received pethidine (self-administered intranasal fentanyl provided more expressive responses emphasising the route provided a strong sense of control and enablement. Key conclusions Route of administration influenced the women’s experience, more women who self-administered intranasal fentanyl reported positive emotional responses, with women reporting increased autonomy and satisfaction. Whereas, women who relied on the midwife to administer subcutaneous fentanyl or intramuscular pethidine, were more often focused on the physical effect of the drug. Pethidine was the least preferred option due to adverse effects. Implications for practice For women requesting parenteral analgesia, fentanyl administered by less invasive routes offers women additional options that may better meet their emotional, cognitive and physical needs than the current practice of administering intramuscular pethidine

Developing an accurate system of measuring colour in a venous leg ulcer in order to assess healing

Objective: To develop a standardised method of assessing venous ulceration, based on the colour of an ulcer bed and the surrounding skin. Method: This pilot study involved taking three sequential digital photographsduring an episode of care and measuring the colour using image analysis software.Ten episodes of care were used for data collection. Results: Based on previous research, a threshold of ≤3° of colour and 3% of saturation was selected to indicate the reliability of the system.The mean of the colour measurements was inside the reliability threshold when measuring an ulcer bed, but outside the threshold for measuring the surrounding skin. Conclusion: The results indicate that the system provides consistent visual representation of a venous leg ulcer. Declaration of interest: None