Clinical study on the effect of remifentanil patient-controlled intravenous labor analgesia compared to patient-controlled epidural labor analgesia
, 2, 1, 1
Abstract
Objectives: This study aims to investigate the safety and efficacy of remifentanil for patient-controlled intravenous labor analgesia as an alternative to the patient-controlled epidural labor analgesia.
Material and Methods: Out of 453 parturients who volunteered for labor analgesia and were selected as research objects, 407 completed the trial. They were divided into the research group (n = 148) and the control group (n = 259; patient-controlled epidural analgesia). In the research group, the first dose of remifentanil, the background dose and the patient- -controlled analgesia (PCA) dose were 0.4 μg/kg, 0.04 μg/min and 0.4 μg/kg, respectively, with a lockout interval of 3 min. The control group was given epidural analgesia. The first dose and background dose were 6–8 mL, and PCA dose and the locking time of analgesia pump were 5 mL and 20 min, respectively. The following indexes of the two groups were observed and recorded: the analgesic and sedative effects on parturient, labor process, forceps delivery, cesarean section rate and adverse reactions, and maternal and neonatal conditions.
Results: (1) The onset time of analgesia in the research group was (0.97 } 0.08) min, which was noticeably shorter than that in the control group ([15.74 } 1.91] min), with a statistically significant difference (t = –93.979, p = 0.000). (2) There was no significant difference in the labor process, forceps delivery, cesarean section rate and neonatal condition between the two groups (p > 0.05).
Conclusions: Remifentanil patient-controlled intravenous labor analgesia has the advantage of rapid onset of labor analgesia. Although its analgesic effect is not as accurate and stable as epidural patient-controlled labor analgesia, it shows a high level of maternal and family satisfaction.
Keywords: remifentanilepidural analgesiapatient-controlledepidural infusionanalgesia
References
- Althaus J, Wax J. Analgesia and anesthesia in labor. Obstet Gynecol Clin North Am. 2005; 32(2): 231–244.
- Logtenberg S, Oude Rengerink K, Verhoeven CJ, et al. Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia: a randomised equivalence trial. BJOG. 2017; 124(4): 652–660.
- Schnabel A, Hahn N, Broscheit J, et al. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol. 2012; 29(4): 177–185.
- Melber AA. Remifentanil patient-controlled analgesia (PCA) in labour - in the eye of the storm. Anaesthesia. 2019; 74(3): 277–279.
- Kan RE, Hughes SC, Rosen MA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects. Anesthesiology. 1998; 88(6): 1467–1474.
- Tveit TO, Seiler S, Halvorsen A, et al. Labour analgesia: a randomised, controlled trial comparing intravenous remifentanil and epidural analgesia with ropivacaine and fentanyl. Eur J Anaesthesiol. 2012; 29(3): 129–136.
- Balki M, Kasodekar S, Dhumne S, et al. Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens. Can J Anaesth. 2007; 54(8): 626–633.
- Marr R, Hyams J, Bythell V. Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2013; 68(3): 283–287.
- Bonner JC, McClymont W. Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2012; 67(5): 538–540.
- Liu ZQ, Chen XB, Li HB, et al. A comparison of remifentanil parturient-controlled intravenous analgesia with epidural analgesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2014; 118(3): 598–603.
- Lee M, Zhu F, Moodie J, et al. Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials. J Clin Anesth. 2017; 39: 57–63.
- Stocki D, Matot I, Einav S, et al. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014; 118(3): 589–597.
- Volikas I, Butwick A, Wilkinson C, et al. Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour. Br J Anaesth. 2005; 95(4): 504–509.
- Tveit TO, Halvorsen A, Seiler S, et al. Efficacy and side effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study. Int J Obstet Anesth. 2013; 22(1): 19–25.
- Douma MR, Middeldorp JM, Verwey RA, et al. A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour. Int J Obstet Anesth. 2011; 20(2): 118–123.
- Shen MK, Wu ZF, Zhu AB, et al. Remifentanil for labour analgesia: a double-blinded, randomised controlled trial of maternal and neonatal effects of patient-controlled analgesia versus continuous infusion. Anaesthesia. 2013; 68(3): 236–244.
- Daly O, Kelly KP, McCormack JG, et al. Remifentanil PCA in labour. Anaesthesia. 2013; 68(7): 780–781.
- D'Onofrio P, Novelli AM, Mecacci F, et al. The efficacy and safety of continuous intravenous administration of remifentanil for birth pain relief: an open study of 205 parturients. Anesth Analg. 2009; 109(6): 1922–1924.
- Marwah R, Hassan S, Carvalho JCA, et al. Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study. Can J Anaesth. 2012; 59(3): 246–254.
- Lu G, Yao W, Chen X, et al. Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020; 20(1): 151.
- Birnbach DJ, Ranasinghe JS. Is remifentanil a safe and effective alternative to neuraxial labor analgesia? It all depends. Anesth Analg. 2014; 118(3): 491–493.
- Volmanen P, Sarvela J, Akural EI, et al. Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double-blinded study. Acta Anaesthesiol Scand. 2008; 52(2): 249–255.
- Stourac P, Kosinova M, Harazim H, et al. The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016; 160(1): 30–38.
- Frauenfelder S, van Rijn R, Radder CM, et al. Patient satisfaction between remifentanil patient-controlled analgesia and epidural analgesia for labor pain. Acta Obstet Gynecol Scand. 2015; 94(9): 1014–1021.
- Freeman LM, Bloemenkamp KW, Franssen MT, et al. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial. BMJ. 2015; 350: h846.
- Ohashi Y, Baghirzada L, Sumikura H, et al. Remifentanil for labor analgesia: a comprehensive review. J Anesth. 2016; 30(6): 1020–1030.
- Jelting Y, Weibel S, Afshari A, et al. Patient-controlled analgesia with remifentanil vs. alternative parenteral methods for pain management in labour: a Cochrane systematic review. Anaesthesia. 2017; 72(8): 1016–1028.
- Logtenberg SLM, Vink ML, Godfried MB, et al. Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands. Int J Obstet Anesth. 2019; 39: 22–28.
- Van de Velde M. Patient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider. Curr Opin Anaesthesiol. 2015; 28(3): 237–239.
- Ortiz JU, Hammerl T, Wasmaier M, et al. Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome. Geburtshilfe Frauenheilkd. 2019; 79(4): 389–395.
