Intravenous fentanyl PCA during labour

Abstract

To evaluate the usefulness of intravenous patient-controlled analgesia (PCA) fentanyl for labour analgesia, its effectiveness for maternal pain and safety for the fetus and newbom.Methods: Twenty primigravidas were randomised to receive intravenous PCA fentanyl or epidural analgesia for labour pain. Maternal pain, heart rate and arterial oxyhaemoglobin saturation (Sp02) were monitored. Fetal and neonatal monitoring induded cardiotocogram (CTG), APG/~ neurological scoring and static-charge-sensitive bed (SCSB) recording for 12 hr postnatally with ECG and SpOr Fentanyt concentrations and pH of umbilical artery and vein were analysed. l~sull~: Ini~ally, epidural analgesia was more effective (P = 0.0 I), and three patients in the fentanyl group were given epidural due to unsatisfactory pain relief. Overall satisfaction for analgesia did not differ between the groups. Maternal side-effects were more frequent in the fentanyl group (dizziness and tiredness most often, P = 0.0001 ). Severe sideeffects were not reported. In CTG there were no differences between groups. All the newboms were healthy, APGAR and pH were normal. Naloxone was not used. Neurological scoring was similar in both groups. In 12 hr monitoring heart rate, breathing frequency and movement time were similar in both groups, but SpO~ was lower in the fentanyt group (P < 0.00 I). Umbilical cord fentanyt concentrations were low or beyond the detection limit. Cx)nd~ion: Intravenous fentanyl can be used for labour analgesia with the doses reported here as an altemative to epidural analgesia. However, the fetus and neonate must be appropriately monitored. Naloxone and oxygen should be available if neonatal distress occurs.Obj~cis : ~aluer rimportance de I'analg&ie intraveineuse auto-contr61& (PCA) au fentanyl en analg~sie obst~tri-cale en tenant compte de son efl~cacitE et de la s&uritE foeto-matemelle. M~J~xlm : Vingt primipares ont Et6 assign&s al6atoirernent ~ recevoir soit du fentanyl intraveineux en PCA soit une analgEsie Epidurale dans le but de soulager la douleur de I'accouchement. La douleur maternelle, la fr~luence cardiaque et la saturation art&ielle (SpO2) ont EtE not&~s. Le monitorage foetal et n~natal inclualt la cardiotocographie (CTG), le score d'APGAFL r~valuation neurologique et I'enregistrement au lit sensible ~ la statique (SCSB) pendant 12 h apr~s la nalssance avec I'I~CG ET la SpO 2. La concentration de fentanyt et le pH de rart&e et de la veine ombilicales Kent mesur~s, ]L~ultats : Initialement, I'analg~sie Epidurale s'est av&& plus ef~ce (P = 0,0 I) et trois pa~entes clu groupe fentanyl ont dO accepter une analg&ie Epidurale ~ cause du manque de soulagement. La satisfaction globale en rapport avec t'analg~'ie n'a pas diffEr~ entre les groupes. Des effets maternels secondaires sans gravit~ sont survenus plus souvent dans le groupe fentanyt (surtout des &ourdissements et de la fatigue, P = 0,0001). Le CTG n'a pas r~vEIE de differences intergroupes. Tousles enfants sont n8 en 10on ~at avec des scores d'APGAR et des pH normaux. On n'a pas ...

Intravenous patient-controlled analgesia with remifentanil in early labour

“…Sharma et al (1997) reported median (25 th -75 th percentiles) sedation scores of 0 (0-0) and 1 (0-2) in EDA and pethidine IVPCA groups in a large study including 715 parturients on a categorical observer scale (0 = awake and alert, 1 = awake but drowsy, 2 = asleep but arousable, 3 = asleep but difficult to arouse, 4 = unresponsive) (p < 0.001). This finding was consistent with other studies comparing EDA with long-acting systemic opioids (Sharma et al 1997, Nikkola et al 1997, Jain et al 2003, Halpern et al 2004.…”

“…Surprisingly, only three RCTs comparing EDA with systemic opioid analgesia (table 2) have employed the measurement of SaO 2 or other ways to show an effect on respiration, probably reflecting the fact that the obstetric outcome was the primary end point in most of the studies. Nikkola et al (1997) noted a SaO 2 > 95% in all parturients receiving either EDA with 0.5% bupivacaine or IVPCA fentanyl. Jain et al (2003) did not report any parturient with a respiratory rate < 8 when EDA was compared with intramuscularly administered opioids.…”

Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study

“…Similar degrees of analgesia have been shown in other studies; however, most of these studies evaluated analgesic efficacy only for the first two to three hours after initiation of PCA. [10][11][12][13][14]25 One possible explanation for an increase in pain scores towards the end of labour in our study was the practice of continuing PCA into the second stage of labour when the intensity and frequency of pain are likely to be greater. Douma et al 10 observed superior analgesia with remifentanil compared with fentanyl in labouring patients; however, the difference was evident only during the first hour of treatment, and pain scores returned to baseline values in both groups within three hours of initiation of PCA.…”

“…34 Despite the lack of visible neonatal depression at birth, during a 12-hr monitoring period after birth, Nikkola et al observed numerous events of desaturation (SpO 2 B 90%) in neonates of mothers who received fentanyl PCA. 25 This indicates the potential for fentanyl-due to its long half-life-to cause delayed respiratory depression in neonates after PCA use.…”

“…To date, the literature supports the safety of remifentanil from a neonatal standpoint, 6,7,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] while several studies have shown that fentanyl PCA may be associated with neonatal depression. 1,9,[25][26][27][28] Therefore further research is needed to ensure the safety of these drugs while used for IVPCA in labouring women. Based on our previous studies, 15,29 a policy has been implemented at our institution in the last five years for the use of both remifentanil and fentanyl IVPCA for labour; however, the regimens differ from those reported in the study by Douma et al…”