Differences in Maternal Temperature During Labour With Remifentanil Patient-controlled Analgesia or Epidural Analgesia: A Randomised Controlled Trial

Abstract

(Int J Obstet Anesth. 2015;24(4):313–322) Two popular techniques for the treatment of labor pain are epidural analgesia (EA) and intravenous remifentanil patient-controlled analgesia (RPCA). Remifentanil is a μ-opioid receptor agonist with a rapid onset of action and short latency to peak analgesic effect. This randomized, controlled trial was performed to compare the rate of maternal fever (temperature ≥38°C) in parturients receiving RPCA with those receiving either EA or no analgesia. The authors hypothesized that fever would be more prevalent in patients receiving EA compared with patients receiving either RPCA or no analgesia. The secondary objectives studied included differences in maternal oxygen saturation (SpO2), nausea, vomiting, sedation, pruritus, hypotension, and neonatal outcome.

The effects of combined spinal-epidural analgesia and epidural anesthesia on maternal intrapartum temperature: A randomized controlled trial

“…There were signi cant differences at the time points of 5 h, 6 h, and 9 h between the two groups. This upward trend in maternal temperature has been reported in many studies [7,[25][26][27]. Moreover, in this study, women who received EA had a higher risk of developing maternal fever than those who received CSEA.…”

“…However, both randomized trials and observational studies have indicated that labor epidural analgesia is associated with the development of maternal fever or temperature elevation [1][2][3][4]. The risk of epiduralrelated fever has been reported to range from 15-42% in nulliparas [5][6][7][8][9][10][11][12]. Maternal intrapartum fever is considered to be a risk factor for both the mother and the neonate, including an increased amount of unnecessary maternal antibiotic use, and number of neonatal evaluations for sepsis and other adverse neonatal outcomes [13,14].…”

SP22.1 Remifentanil PCIA has no place in labor analgesia

“…In a 2015 randomized controlled trial, Douma et al reported a significant higher incidence of maternal fever associated with epidural (37%) compared with remifentanil PCIA (10%). 32 In another 2017 randomized trial, Logtenberg et al did not find any difference in the incidence of maternal fever between Remifentail PCIA (10%) and epidural analgesia (8%) 33 In a 2020 meta-analysis including 6 randomized controlled trial and 3341 patients, Lu et al concluded that there is no solid evidence to illustrate that intrapartum maternal fever is lower with Remifentanil PCIA than with epidural analgesia. 22 Risks of decreasing epidural rate An increased use of alternative analgesia such as Remifentanil PCIA might carry the risk of an increased use of general anesthesia for intrapartum cesarean section or other obstetrical indications.…”

Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally

“…Two studies reported no association between epidural analgesia and neonatal events. 19 , 20 In contrast, other investigations have reported that epidural analgesia use was associated with increased neonatal sepsis and antibiotic treatment in neonates. 21 , 22 , 23 However, neonatal infection was not the primary outcome of those studies, 21 , 22 , 23 and the number of confirmed sepsis cases was small.…”