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Published online: 2021-04-15
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Analgesic efficacy of remifentanil patient-controlled analgesia versus combined spinal-epidural technique in multiparous women during labour

Iva Blajic1, Tea Zagar2, Neli Semrl2, Nejc Umek3, Miha Lucovnik24, Tatjana Stopar Pintaric31
DOI: 10.5603/GP.a2021.0053
·
Pubmed: 33914329
Affiliations
  1. Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia
  2. Faculty of Medicine, University of Ljubljana, Slovenia
  3. Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Slovenia
  4. Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slovenia

open access

Ahead of Print
ORIGINAL PAPERS Obstetrics
Published online: 2021-04-15

Abstract

Objectives: To compare the analgesic profile of remifentanil patient-controlled analgesia (RPCA) and combined spinal-epidural analgesia technique (CSEA) in multiparous women during the entire labour. We hypothesized that CSEA would provide a better and more sustained pain reduction than RPCA.

Material and methods: A prospective observational trial under ID NCT02963337 at a university hospital in Slovenia 2017–2018. Analgesic efficacy, satisfaction with pain-relief, adverse effects, labour progress, and outcomes between RPCA (80) and CSEA (81) were compared.

Results: CSEA provided significantly lower pain scores during the entire labour. Compared to baseline, significant pain reduction was recorded in both groups after 15 min. No difference was recorded compared to baseline with RPCA and CSEA after 45 and 90 mins, respectively. CSEA provided higher satisfaction than RPCA (5 [5–5] vs 5 [4–5], p < 0.0001). More patients with CSEA opted for the same technique for the next labour [CSEA; 77 (95%) vs RPCA; 65 (81%), p = 0.003]. No crossovers were observed. RPCA was associated with desaturation (34%), bradypnea (21%) and apnoea (25%), which were transitional and easily managed. None had severe sedation. No differences were recorded in labour progress and outcomes. Apgar scores were reassuring in all neonates (> 8). None had umbilical artery pH < 7.0.

Conclusions: In multiparas, CSEA provided superior analgesia and satisfaction than RPCA. Nevertheless, RPCA provided a satisfactory experience, suggesting it could be used when neuraxial analgesia is not available, preferred, or contraindicated. In that case, constant presence of midwife is mandatory for management of clinically significant hypoventilation.

Abstract

Objectives: To compare the analgesic profile of remifentanil patient-controlled analgesia (RPCA) and combined spinal-epidural analgesia technique (CSEA) in multiparous women during the entire labour. We hypothesized that CSEA would provide a better and more sustained pain reduction than RPCA.

Material and methods: A prospective observational trial under ID NCT02963337 at a university hospital in Slovenia 2017–2018. Analgesic efficacy, satisfaction with pain-relief, adverse effects, labour progress, and outcomes between RPCA (80) and CSEA (81) were compared.

Results: CSEA provided significantly lower pain scores during the entire labour. Compared to baseline, significant pain reduction was recorded in both groups after 15 min. No difference was recorded compared to baseline with RPCA and CSEA after 45 and 90 mins, respectively. CSEA provided higher satisfaction than RPCA (5 [5–5] vs 5 [4–5], p < 0.0001). More patients with CSEA opted for the same technique for the next labour [CSEA; 77 (95%) vs RPCA; 65 (81%), p = 0.003]. No crossovers were observed. RPCA was associated with desaturation (34%), bradypnea (21%) and apnoea (25%), which were transitional and easily managed. None had severe sedation. No differences were recorded in labour progress and outcomes. Apgar scores were reassuring in all neonates (> 8). None had umbilical artery pH < 7.0.

Conclusions: In multiparas, CSEA provided superior analgesia and satisfaction than RPCA. Nevertheless, RPCA provided a satisfactory experience, suggesting it could be used when neuraxial analgesia is not available, preferred, or contraindicated. In that case, constant presence of midwife is mandatory for management of clinically significant hypoventilation.

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Keywords

labour analgesia; multiparity; combined spinal-epidural analgesia; remifentanil patient-controlled analgesia; pregnancy

About this article
Title

Analgesic efficacy of remifentanil patient-controlled analgesia versus combined spinal-epidural technique in multiparous women during labour

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-04-15

DOI

10.5603/GP.a2021.0053

Pubmed

33914329

Keywords

labour analgesia
multiparity
combined spinal-epidural analgesia
remifentanil patient-controlled analgesia
pregnancy

Authors

Iva Blajic
Tea Zagar
Neli Semrl
Nejc Umek
Miha Lucovnik
Tatjana Stopar Pintaric

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