A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour

Douma, M.R.; Middeldorp, J.M.; Verwey, R.A.; Dahan, Albert; Stienstra, Rudolf

doi:10.1016/j.ijoa.2010.11.009

Cited by 77 publications

(91 citation statements)

References 12 publications

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“…In contrast, remifentanil is associated with a higher risk of nausea and vomiting, decreased oxygen saturation under 95% and dose dependent level of sedation 34,39,41 . There was no difference in either cardiotocograph interpretation or neonatal outcome between epidural analgesia and remifentanil 15,28,34,41,43,44 . No effect on higher incidence of instrumental deliveries, Caesarean Sections or length of (Table 3) (ref.…”

Section: Epidural Analgesiamentioning

confidence: 85%

“…The combined data from the meta-analysis shown in Table 6, revealed a statistically significant decrease in the VAS in the remifentanil group ( 27 Douma et al 33 Douma et al 43 El-Kerdawy et al 42 Evron et al 28 Evron et al 35 Ismail et al 44 Ng et al 40 Stocki et al 17 Štour et al 15 Thurlow et al 46 Tveit et al 34 Volikas et al 26 Volmanen et al 37 Volmanen et al 41 References Difference in means and 95% CI Comparison of IV opioid analgesia, Entonox, neuraxial analgesia on neonatal outcome Egan 13 Pharmacokinetics and pharmacodynamics of remifentanil Leong et al 38 A comparison between remifentanil and meperidine for labor analgesia Hill et al 55 The use of remifentanil in obstetric anaesthesia and analgesia Hinova et al 56 Effi cacy of remifentanil as a labor analgesic Volmanen et al 57 Comparison of paracervical block, pudendal block, IV remifentanil and nitrous oxide Kranke et al …”

Section: Primary Endpointmentioning

confidence: 99%

“…Currently, few probably doubt that remifentanil administered in the PCA is a less effective analgesic than epidural analgesia 14,15 . Despite these findings, most studies found no difference in maternal satisfaction with applied method of analgesia 15,18,34,[41][42][43][44] . This would suggest that remifentanil provides a weaker but highly acceptable analgesia for the parturient.…”

Section: Epidural Analgesiamentioning

confidence: 99%

See 2 more Smart Citations

The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature

Štourač¹,

Kosinová²,

Harazim³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background and Aims. Although epidural analgesia is still regarded as the gold standard for labour analgesia due to its efficacy, in cases of contraindication, systemic remifentanil is an alternative. Since the first demonstration of the safety of remifentanil in obstetric analgesia in 1996, this has been repeatedly confirmed for both mother and newborn. The aim of this meta-analysis is to evaluate recently published studies (up to December 2014) on the analgesic efficacy of remifentanil during labour (as a Visual Analogue Scale (VAS) decrease in the first hour by 2 or more). Methods. Search of the US National Library of Medicine, National Institutes of Health (www.pubmed.gov), SCOPUS database (www.scopus.com) and Web of Science database (www.webofknowledge.com) using the key words "labour" and "remifentanil". 44 identified articles were included in the review and 15 published randomised controlled studies were incorporated into the meta-analysis. This was based on the fixed model and described by differences in the VAS between t=0 and t=1 hour after remifentanil administration using the 95% confidence interval (CI). The analysis was computed using the Comprehensive meta-analysis version 2.2.064. Results. The combined data from the meta-analysis showed a statistically significant decrease in VAS in the remifentanil group. From a comparison of the CIs of summary estimates with a cut-off decrease of VAS 2, for the fixed model, there was a statistically significantly greater decrease in VAS than the cut-off. In the systematic review, we describe possible modes of application, dosage and side-effects for mother, fetus/ newborn. Conclusion. The meta-analysis presented here confirms that remifentanil for labour analgesia is effective but questions remain which can only be answered by further randomized trials.

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Section: Epidural Analgesiamentioning

confidence: 85%

Section: Primary Endpointmentioning

confidence: 99%

Section: Epidural Analgesiamentioning

confidence: 99%

See 1 more Smart Citation

The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature

Štourač¹,

Kosinová²,

Harazim³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

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“…Sin embargo, comparado con la analgesia neuroaxial en nulíparas, los resultados son peores 97 . La sensación global es que la analgesia con remifenta-nilo en PCA, aunque merece la pena y da buenos resultados 98 , con elevados índices de satisfacción maternos 99 , no llega al nivel de idoneidad de la analgesia neuroaxial 100,97 y a menudo se relega a situaciones donde la epidural no es factible / viable 101,102 . Debido a sus potenciales efectos adversos, es necesario informar a la paciente 103 , monitorizarla adecuadamente 104,105 y formar al personal de enfermería y matronas en su empleo.…”

Section: Opioidesunclassified

Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

Ortiz-Gómez

Palacio-Abizanda

Fornet-Ruiz

2014

Anales Sis San Navarra

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Se insiste en la necesidad de aplicar una aproximación terapéutica multifactorial a la embarazada, no limitándonos solo a eliminar el dolor del parto.Palabras clave: Analgesia obstétrica. Dolor del parto. Epidural. Analgesia controlada por el paciente. Remifentanilo. AbsTrAcTEpidural analgesia is now the method of choice for the treatment of pain in labour and delivery. However, this technique may fail and provide inadequate or null alleviation to the mother. This paper reviews the risk factors, possible causes and possible therapeutic alternatives to inadequate analgesia, whether pharmacological therapies (neuroaxial, peripheral blocks or analgesic administration via intravenous or inhalational routes) or non-pharmacological ones (relaxation techniques, psychological or mechanical).In all possible cases the efficacy and indications of alternative therapies based on the published literature are reviewed, especially from the point of view of evidence-based medicine.The need is underscored of a multifactorial therapeutic approach to the pregnant woman, not just restricting ourselves to eliminating the pain of childbirth.

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“…Strict hospital guidelines are required avoid drug overdose, causing potentially life-threatening side effects such as respiratory depression [53]. Recently, the feasibility of the use of intravenously delivered remifentanil during labor by PCA, under strict observation, has been demonstrated [54][55][56][57][58][59]. Large randomized controlled trials are required to prove that this technique can become an alternative for epidural analgesia during labor [60 • ].…”

Section: Examples Of Closed-loop Drug Administrationmentioning

confidence: 99%

Automated Drug Delivery in Anesthesia

Neckebroek

Smet²,

Struys

2012

Curr Anesthesiol Rep

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Automated drug administration by closed-loop systems has been proposed to optimize drug administration during anesthesia and sedation. Closed-loop systems are able to make decision on their own and try to reach and maintain a preset target. This review describes the milestones and recent development in automated drug delivery systems applicable during sedation, anesthesia and postoperative pain relief.

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A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour

Cited by 77 publications

References 12 publications

The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature

The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature

Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

Automated Drug Delivery in Anesthesia

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