Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double‐blinded study

Volmanen, Petri; Sarvela, J.; Akural, E. I.; Raudaskoski, Tytti; Korttila, K.; Alahuhta, Seppo

doi:10.1111/j.1399-6576.2007.01509.x

Cited by 111 publications

(135 citation statements)

References 21 publications

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“…The incidence of maternal desaturation (SpO 2 \ 95%) has been shown to be 40-74% after remifentanil and up to 56% after fentanyl PCA. 10,12,15,22,33 The lower rate of maternal desaturation seen in our study, while providing similar analgesic effects, suggests the use of optimum dose regimens in our patients. Furthermore, the desaturation episodes observed in our patients were transient and responded to deep breathing and oxygen supplementation via nasal prongs.…”

Section: Discussionsupporting

confidence: 64%

“…11 It is possible that remifentanil administered as an infusion only is not associated with as much desaturation as its administration in the form of PCA boluses with or without infusions. 10,12,15,17,33 Nevertheless, continuous pulse oximetry during opioid administration for labour analgesia is warranted regardless of the PCA protocol used. It was concerning to observe a higher number of neonates in the fentanyl (59%) group than in the remifentanil (25%) group requiring resuscitation.…”

Section: Discussionmentioning

confidence: 99%

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

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

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Purpose We undertook a retrospective study to compare the analgesic efficacy and effects on neonatal outcome of administering either remifentanil or fentanyl intravenous patient-controlled analgesia (IVPCA) during labour. Methods A five-year retrospective cohort study was undertaken of women with more than 24 weeks of gestation who had received either IVPCA remifentanil or fentanyl for labour analgesia at Mount Sinai Hospital. The sampling timeframe was from November 2005 to March 2010. The standard IVPCA regimen for the remifentanil group consisted of a PCA bolus 0.25 lgÁkg -1 with a lockout interval of two minutes, a four-hour limit of 3 mg, and a background infusion of 0.025-0.05 lgÁkg -1 Ámin -1 , whereas the standard IVPCA regimen for the fentanyl group consisted of a PCA bolus 25-50 lg with a lockout interval of three to six minutes and a four-hour limit of 1-1.5 mg. The following data were compared: maternal hourly pain scores (verbal pain score scale 0-10), sedation scores (scale 0-3), adverse effects, and neonatal outcomes. Mixed linear modelling was used to analyze longitudinal data on pain scores over time. The exact Wilcoxon test and the Fisher's exact test were used for other comparisons.Results Ninety-eight women were studied. There was no significant difference in the model-adjusted pain scores between the two groups (P = 0.86). There was a moderate decrease in pain scores in both groups compared with the baseline values. There was no difference in maternal side effects between the two groups, although transient oxygen desaturation was observed more frequently in the remifentanil group than in the fentanyl group (13% vs 2%, respectively; odds ratio, 7.32; 95% confidence interval [CI], 0.85 to 63.3). A larger number of neonates in the fentanyl group required resuscitation compared with neonates in the remifentanil group (59% vs 25%, respectively; odds ratio, 4.33; 95% CI, 1.75 to 10.76); adjusted (44% vs 8%, respectively; odds ratio, 8.56; 95% CI, 2.17 to 33

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

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“…[7][8][9][10] Tolerance and hyperalgaesia have also been described. 7,8 The concurrence of type I NF and FVL deficiency in a pregnant patient is an unusual challenge both from an obstetric point of view and in relation to the choice of analgaesia. Although the use of remifentanil is gradually becoming more common among obstetric patients, it is still a subject of some debate.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…7,8 It also has a very short half-life of approximately three minutes, independent of hepatic or renal function. 8 An infusion rate of 0.1 μg/kg/minute preserves spontaneous breathing among patients who are awake. 9 However, arterial hypotension, muscle stiffness, nausea and vomiting, chills, bradycardia, apnoea and respiratory depression have been reported effect hydrocephalus or suggestive imaging findings have a minimal risk of herniation following a dural puncture.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Remifentanil Analgaesia for an Obstetric Patient with Type I Neurofibromatosis and a Factor V Leiden Mutation

Gálvez

Errando

Serrano

et al. 2018

Sultan Qaboos Univ Med J

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Type I neurofibromatosis is characterised by altered skin pigmentation and the growth of benign tumours, particularly along the peripheral nerves and central nervous system. We report a 36-year-old primigravida woman in labour who was admitted to the obstetric suite of the Hospital Sant Joan de Déu, Barcelona, Spain, in 2007 with hypothyroidism, type I neurofibromatosis and a factor V Leiden mutation. Due to a lack of cranial and spinal imaging data, an epidural was not indicated; instead, continuous intravenous remifentanil analgaesia was administered. The remifentanil infusion was self-titrated by the patient using a visual analogue scale, with the dosage ranging from 0.01 to 0.25 μg/kg/minute. Due to rotational dystocia, Kjelland-type forceps were used during the delivery. After birth, the infant was found to have Apgar scores of 9 and 10, with no maternal or neonatal adverse effects observed. Although still controversial, remifentanil may be a successful alternative for analgaesia in similar cases; however, the specific risks and benefits for each patient should be considered prior to administration.

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Epidural versus non-epidural or no analgesia in labour

Anim‐Somuah¹,

Smyth²,

Howell³

2005

Cochrane Database of Systematic Reviews

218

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Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double‐blinded study

Abstract: In terms of pain scores, epidural analgesia is superior to that provided by IV remifentanil. However, there was no difference in the pain relief scores between the treatments.

Cited by 111 publications

References 21 publications

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

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

Intravenous Remifentanil Analgaesia for an Obstetric Patient with Type I Neurofibromatosis and a Factor V Leiden Mutation

Epidural versus non-epidural or no analgesia in labour

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