Effectiveness of subcutaneous injection of sterile water to the lower back for pain relief in labor. Relief of low back labor pain by using intracutaneous injections of sterile water: a randomized clinical trial. The effect of sterile water blocks on low back labor pain. Subcutaneous sterile water injection for labour pain: a randomised controlled trial. Intracutaneous Injections of Sterile Water over the Secrum for Labour Analgesia. Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain. Labour pain treated with cutaneous injections of sterile water: a randomised controlled trial.
The analgesic efficacy of subcutaneous injection of sterile water compared to isotonic saline was investigated in a randomized, controlled study on a total of 100 women in the active phase of labor and who complained of low back pain. Pain perception was rated on a numerical rating scale before and at 10 and 45 minutes after the injection. The initial pain score was the same in both groups and pain relief was expressed by both groups irrespective of the solution injected, but the sterile water group had significantly higher relief scores compared to those receiving saline. This was not influenced by maternal age, parity, education, body mass index, cervical dilatation at intervention or fetal size, suggesting that subcutaneous injection of sterile water to the lower back provides relief from back pain during labor. To study the effectiveness of intracutaneous injections of sterile water in relieving low back pain during labor in Thai women.
                Randomized controlled trial.
                Department of Obstetrics and Gynecology, Taksin Hospital, Bangkok.
                Fifty pregnant women at term, requiring pain relief for severe low back pain during the first stage of labor. The women were randomized to receive either 4 intracutaneous injections of 0.1 mL sterile water (n = 25) or isotonic saline as placebo (n = 25).
                Pain scores measured by visual analogue scale.
                Mean pain scores were significantly lower among the treatment group compared to the placebo group at 30 minutes, 1 and 2 hours after injections (p = 0.018, 0.046, and 0.027 respectively). Mean pain reduction were significantly greater in the treatment group compared to the placebo group at 30 minutes, 1 and 2 hours after injections (p < 0.001). There was no difference between the two groups with regard to time to delivery and rate of instrumental and cesarean delivery.
                The intracutaneous injections of sterile water was found to be an effective treatment against lower back pain during the first stage of labor. To evaluate the analgesic effect of intradermal sterile water blocks, 272 women in labor complaining of severe low back pain were randomly assigned to treatment with either sterile water or saline solution blocks. Pain intensity was assessed on a visual analog scale, before the blocks were given and again 1 and 2 hours later. The groups were equal with regard to age, parity, fetal size, progression of labor, and initial pain scoring. Pain scoring 1 and 2 hours after the blocks were given showed a significantly higher degree of analgesia in the sterile water group. No adverse effects were noted, and patient acceptability was high. About 30% of women experience severe continuous low-back pain in labour, but limited options are available to reduce this pain especially in developing countries and remote areas.
                To evaluate the efficacy of subcutaneous sterile water injection in reduction of labour pain compared with placebo.
                One hundred (100) consecutive patients were enrolled in a double-blind randomised controlled trial. During the first stage of labour with planned normal vaginal delivery, the intervention group (n = 50) received 0.5 mL sterile water injected subcutaneously and the control group (n = 50) received normal saline as a placebo. Pain score was measured before and 10 and 45 min after the injection, using the faces rating scale.
                Low-back labour pain.
                The two groups were not significantly different regarding maternal age and weight, gestational age, parity and gravidity and degree of effacement. The median pain score was equal in both groups prior to the injection. Pain severity was reduced in both groups after the injection. However, the median pain score in the sterile water group was significantly lower than the placebo group 10 min (P < 0.01), as well as 45 min, after the injection (P < 0.01).
                Administering one subcutaneous injection of sterile water in a painful point of the lumbosacral area is effective in reducing low-back pain during labour. During first stage of labour, many women suffer from lower back pain. Since cutaneous afferents from the lower back converge to the dorsal horns in the same segments there is anatomical support for the lower back pain being a referred pain. Intracutaneous injections of sterile water in the skin over the sacrum have been shown to relieve the pain of labour and it is free from negative side effects associated with use of other methods. The study was conducted after approval of institutional ethical committee on 100 pregnant patients admitted to the labour room of Lok Nayak hospital, New Delhi. Patients received 4 intracutaneous injections of sterile water or normal saline 0.5ml in the lumbo-sacral region. Pain scores, progress of labour and fetal outcome were studied. There was significant reduction of pain scores in the sterile water group but not in the normal saline group at 10, 45 and 90 minutes after injection. There was no difference in the progress of labour and fetal outcome between the two groups. To conclude intracutoneous sterile water injections over the sacrum is a simple and effective method to control pain during labour. Two methods for pain relief and relaxation during labour are sterile water injections and acupuncture. In several studies, sterile water injections have been shown to provide good pain relief, particularly for low back pain during labour. The acupuncture studies for pain relief during labour are not as concordant. Therefore, the aim of this study was to explore if there were any differences between acupuncture and sterile water injections regarding pain relief and relaxation during labour.
                A randomised controlled trial. Some 128 pregnant women at term were randomly assigned to receive acupuncture (n=62) or sterile water injections (n=66). The primary endpoint was to compare the differences between pre-treatment pain levels and maximum pain in the 2 groups.
                The main results of this study were that sterile water injections yielded greater pain relief (p<0.001) during childbirth compared to acupuncture. The secondary outcome showed that women in the sterile water group had a higher degree of relaxation (p<0.001) compared to the acupuncture group. The women's own assessment of the effects also favoured sterile water injections (p<0.001). There were no significant differences regarding requirements for additional pain relief after treatment between the 2 groups.
                Women given sterile water injection experience less labour pain compared to women given acupuncture. To evaluate the relief of pain in labour with subcutaneous and intracutaneous injections of sterile water, compared with placebo.
                Randomised controlled trial.
                Labour ward with approximately 3000 deliveries annually in a suburban area near Gothenburg, Sweden.
                Ninety-nine pregnant women at term, requiring pain relief for severe lower back pain during the first stage of labour. The women were randomised to receive four injections of 0.1 mL sterile water (without salt) intracutaneously (n = 33), four injections of 0.5 mL sterile water subcutaneously (n = 33) or placebo treatment (n = 33).
                Reduction of labour pain measured by visual analogue scale.
                The median visual analogue scale pain score for labour pain was significantly lower compared with initial values in the two study groups and compared with placebo at 10 and 45 minutes after treatment. The median reductions in visual analogue scores after 10 minutes were 5.0 cm and 4.5 cm in the intracutaneous and subcutaneous injection groups, respectively; women in the placebo group scored a median reduction of 1.7 cm. After 45 minutes the median reductions in the visual analogue scores were 4.9 cm and 4.0 cm in the intracutaneous and subcutaneous injection groups, respectively, compared with 1.0 cm for women in the placebo group. No significant differences in analgesic effect or pain experienced during administration were found between the two study groups.
                The new subcutaneous method of administering sterile water, as well as the earlier described intracutaneous injection method, were effective for the relief of pain in labour.
The outcomes reported severely limit conclusions for clinical practice. We found little robust evidence that sterile water is effective for low back or any other labour pain. Neither did we find any difference in delivery or other maternal or fetal outcomes. Further large, methodologically rigorous studies are required to determine the efficacy of sterile water to relieve pain in labour.