Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

Abstract

BackgroundUnsatisfactory analgesia would occur frequently during repeated cesarean section under epidural anesthesia. The aim of this study is to observe the effects of intravenous remifentanil on maternal comfort, maternal and neonatal safety during repeated cesarean section under epidural anesthesia.MethodsA total of 80 parturients undergoing repeated cesarean section were involved in the study. The patients were randomly divided into the intravenous remifentanil- assisted epidural group (group R) and epidural group (group E), respectively (n = 40). In group R, the remifentanil was continuously intravenously infused as an adjuvant to epidural anesthesia. In group E, 0.75% ropivacaine epidural or intravenous ketamine was administered as needed. Parturient baseline characteristics, vital signs, VAS scores, and comfort scores during surgery were recorded. Adverse effects were also recorded.ResultsA total of 80 patients were enrolled in the current study and the final analyses included 39 patients in group R and 38 patients in group E. No differences in patients’ baseline characteristics were found between the two groups (p > 0.05). Compared with group E, the comfort score was significantly higher in group R (9.1 ± 1.0 vs. 7.5 ± 1.3, p < 0.001), whereas the maximum VAS score was significantly lower in group R (1.8 ± 1.2 vs. 4.1 ± 1.0, p < 0.001). Maternal and neonatal adverse effects did not differ between the two groups during surgery (p > 0.05).ConclusionsContinuous intravenous infusion of low-dose remifentanil can significantly improve the experience of parturients undergoing repeated cesarean section under epidural anesthesia, without noticeable maternal or neonatal adverse effects.Trial registrationThis study was pre-registered at http://www.chictr.org.cn/index.aspx (ChiCTR1800018423) on 17/09/2018.

The effects of intravenous remifentanil on umbilical artery serum-derived exosomes in parturients undergoing epidural anesthesia: a randomized trial

“…Continuous intravenous administration of remifentanil had little effect on uterine contraction, given that the dose of oxytocin administration and the total volume of blood loss were comparable between two groups. And, consistent with previous studies, no significant adverse effects on neonates were reported [ 1 , 25 ]. These findings suggested that this intravenous remifentanil administration protocol would be safe and effective as an adjunct to epidural anesthesia.…”

“…Remifentanil, a commonly used analgesic in obstetric anesthesia, could provide effective analgesia during monitored anesthesia care in a general patient population with minimal effects on respiration and hemodynamics at dose of 0.1 μg/kg/min [ 15 ]. And similar outcomes were observed in parturients who were continuously administered 0.05 μg/kg/min remifentanil [ 1 ]. For repeated C-section parturients who require intensive analgesia during surgical procedures, the dosage and method of remifentanil infusion are of the utmost importance.…”

“…China's "open childbirth policy" is anticipated to increase the number of women undergoing repeated cesarean section (C-section). C-section has typically been performed under epidural anesthesia due to its safety and controllability [ 1 ]. However, the preexisting abdominal adhesion and a scarred uterus considerably increase the painful response to visceral traction, diminish the efficacy of epidural anesthesia, and prolong the duration of the operation [ 2 ].…”

“…As an ultrashort-acting μ receptor agonist that is rapidly metabolized without residual effect, remifentanil is widely recommended in anesthesia for obstetric surgery [ 4 ]. Continuous intravenous infusion of low-dose (0.05 μg/kg/min) remifentanil during epidural anesthesia has been shown to significantly improve the childbirth experience of parturients undergoing repeated C-cesarean without significant maternal or neonatal complications [ 1 ]. In the majority of studies, however, the safety of remifentanil in obstetric surgery has been questioned due to the increased incidence of hypoxemia associated with this agent [ 5 ].…”

Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique: Randomized controlled study

“…EA is a popular and safe technique and has a sufficient duration of action for RCD. However, it has the drawback of a long onset time and limited anesthesia plane spread, and IV rescue analgesia is often needed[ 22 ]. The DPE technique is a modified anesthesia method based on CSE; the dura is punctured using a spinal needle, and local anesthetics are introduced into the epidural space via an epidural catheter instead of directly into the subarachnoid space[ 14 ].…”