Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial

Abstract

National Institute for Health Research Clinician Scientist Award.

Remifentanil patient‐controlled analgesia (PCA) in labour – in the eye of the storm

“…Today, there is evidence that pain relief with remifentanil PCA is effective; less effective than neuraxial analgesia, but more effective than long‐acting opioids or nitrous oxide . In view of the high maternal satisfaction rate of the remifentanil group in Wilson et al's study , complete labour pain relief may not be the ultimate goal. Good midwifery care might be equally or more important .…”

“…If pethidine was replaced by remifentanil PCA in UK labour wards, approximately 27,000 women per year would not be exposed to the long‐term risks of instrumental deliveries. This has to be weighed against the approximately 250,000 women per year that would be exposed to a short‐term respiratory risk (extrapolated from ). Several anaesthetic units in the UK have demonstrated that routine use of remifentanil PCA strengthens the skills and reduces the risk of severe respiratory depression .…”

“…Seldom has a trial in women giving birth led to so much media response as the one by Wilson et al published in The Lancet recently . They demonstrated in this open‐label, multi‐centre, randomised controlled trial that the use of intravenous remifentanil patient‐controlled analgesia (PCA) instead of intramuscular pethidine halved the proportion of women needing epidural analgesia for insufficient pain relief, from 41% to 19%, and reduced the rate of instrumental delivery from 26% to 15% . As a consequence, with a lower rate of instrumental delivery, fewer women would be exposed to the associated risks, such as long‐term urinary and faecal incontinence and sexual dysfunction .…”

“…They demonstrated in this open‐label, multi‐centre, randomised controlled trial that the use of intravenous remifentanil patient‐controlled analgesia (PCA) instead of intramuscular pethidine halved the proportion of women needing epidural analgesia for insufficient pain relief, from 41% to 19%, and reduced the rate of instrumental delivery from 26% to 15% . As a consequence, with a lower rate of instrumental delivery, fewer women would be exposed to the associated risks, such as long‐term urinary and faecal incontinence and sexual dysfunction . Putting the high‐quality evidence of this trial into clinical practice would mean using remifentanil PCA as a first‐line analgesic treatment instead of pethidine, and possibly other long‐acting opioids.…”

Spectroscopic Behavior, FMO, NBO Analysis of Pethidine and Diclofenac Drugs by Theoretical Approach

“…A series of pethidine analogs were synthesized and their affinities for the [ 3 H]N-methyl-scopolamine (NMS) binding site on muscarinic acetylcholine receptors were determined [6]. Pethidine has been also used to relieve labor pain [7]. Also, a method for the quantitative determination of pethidine (meperidine) and its metabolic norpethidine (normeperidine) in human hair by LC-MS-MS has been proposed [8].…”