Med. J. Cairo Univ., Vol. 83, No. 1, June: 401-408, 2015 www.medicaljournalofcairouniversity.net Intracutaneous Sterile Water Injections for Relief of Back Pain during Labor AMR H. FARAG, M.D., M.R.C.O.G.*; KHALED S. MOHAMMED, M.D.* and MOHAMMED M. MORSY, M.S.** The Department of Obstetrics & Gynecology, Ain Shams University* and El-Sahel Teaching Hospital**, Cairo, Egypt Abstract Objective: To re-evaluate the role of intracutaneous sterile water injections as a method of back pain relief during labor compared to placebo. Patients and Methods: Randomized, double-blinded, placebo-controlled trial, where sixty laboring patients were randomly allocated into one of two groups. Group I (40 patients) received four injections of sterile water while group II (20 patients) received four injections of normal saline as a placebo intracutaneously to Michaelis' rhomboid during active first stage of labor. Primary outcome was back pain scores according to visual analogue scale immediately before then 10, 45 and 90 minutes after the injections. Secondary outcomes were occurrence of fetal or maternal complications, requesting further analgesia, and acceptance of the technique by the participants for future labors. Results: Pain scores were similar between both groups at time of injections but significantly lower at 10, 45 and 90 minutes in group I compared to group II, with maximal difference at 10 minutes following injections. Also, participants requesting more pain relief were more among group II with a statistically significant difference. Moreover, significantly more participants of group I accepted this technique to be used in their future labors. No side effects or complications were reported throughout the study. Conclusions: Intracutaneous sterile water injection ap- peared to be a safe, effective, inexpensive and acceptable method of back pain relief during labor. Key Words: Intracutaneous – Labor pain – Sterile water. Introduction PAIN perception is variable between individuals and is affected by cultural, personal and educational factors where some people view pain mastering as a self-actualizing experience, while others, seem to accept it as an inevitable part of life [1] . The American College of Obstetricians and Gynecolo- gists (ACOG) in their committee opinion on pain Correspondence to: Dr. Amr H. Farag, E-mail: dr_amrhassaan@hotmail.com relief during labor, stated that “there is no other circumstance where it is considered acceptable for a person to experience untreated severe pain, ame- nable to safe intervention, while under a physician's care” and acknowledged that maternal request is a sufficient reason for pain relief during labor [2] . Epidural analgesia using opiates seems to be the most potent method for pain control in labor [3] . The use of narcotics is also efficient in most cases but is limited by negative side effects namely; maternal nausea, vomiting and drowsiness as well as neonatal respiratory depression [4] . Non-pharma- cological methods have been tried in the form of attention, focusing hypnosis and biofeedback as well as techniques based on the gate-control theory as acupuncture, Trans-cutaneous Electrical Nerve Stimulation (TENS), counter-pressure, abdominal decompression, touch, massage and aroma therapy with varying results while intracutaneous sterile water injection has been used in the last decade for relieving pain in many conditions as renal colics, chronic myofascial pain syndromes [5] . Intracutaneous injections of sterile water in the back skin is a simple and cheap method to provide a medication-free option to laboring women who want to either delay or avoid the use of epidural analgesia or when epidurals are not available or contra-indicated [6] . The aim of this study was to re-evaluate the effect and safety of intracutaneous sterile water injection in relieving lower back pain during the first stage of labor in comparison with saline in- jection in the same site and with the same maneuver as a placebo. Patients and Methods This multi-centre randomized placebo-con- trolled trial was conducted at the labor and delivery 401