Labour analgesia

Tveit, Tor Oddbjørn; Seiler, S.; Halvorsen, A.; Rosland, Jan Henrik

doi:10.1097/eja.0b013e32834dfa98

Cited by 54 publications

(22 citation statements)

References 26 publications

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“…The mean umbilical cord gases in both groups were kept in normal range as well, whereas umbilical arterial/venous pH and base excess were lower in the remifentanil group. Our findings seemed to be different from previous studies [6], [7], [9], [14], [26], [35], which found no effect from remifentanil on neonatal outcomes including umbilical pH and base excess. Despite the fact that remifentanil is easy to be metabolized in the neonates [30], [37], it still has some influence on neonatal status.…”

Section: Discussioncontrasting

confidence: 99%

“…The dosage regimen of remifentanil hydrochloride (Ultiva, GlaxoSmithKline, Oslo, Norway) diluted with saline to a concentration of 20 µg·ml −1 was set to PCA bolus of 0.4 µg·kg −1 , a continuous background infusion at 0.04∼0.05 µg·kg −1 ·min −1 and a lockout time of 5 min. PCA doses were calculated according to estimated bodyweight (body height in centimeters -100) [9], [11], [12].…”

Section: Methodsmentioning

confidence: 99%

“…The day after delivery, parturients were asked about their overall satisfaction with analgesic therapy on a five-point verbal rating scale (0 = very dissatisfied, 1 = dissatisfied, 2 = neutral [neither satisfied nor dissatisfied], 3 = satisfied, 4 = very satisfied), and to express the degree of pain relief likewise on a 5-point categorical scale (0 = very poor, 1 = poor, 2 = moderate, 3 = good, 4 = very good) [9].…”

Section: Methodsmentioning

confidence: 99%

“…But they only evaluated fetal heart rate (FHR), umbilical artery pH and 1 min Apgar scores as fetal outcomes. Another randomised, controlled trial of Tveit et al [9] (EA group 20, RA group 17) reported that remifentanil was more likely to cause sedation and oxygen desaturation, but was safe to neonates. In our recent meta-analysis involving 5 studies, remifentanil IVPCA was not found to afford better pain relief than epidural analgesia, but it did not bring serious adverse outcomes to mother and newborn [10].…”

Section: Introductionmentioning

confidence: 99%

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Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Lin

Tao

et al. 2014

PLoS ONE

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Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (P<0.0001), and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P<0.0001) and a higher sedation score (P<0.0001) within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8±0.4 vs. 3.7±0.6, P = 0.007) and pain relief score (2.9±0.3 vs. 2.8±0.4, P<0.0001) compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P<0.0001) was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation.

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Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Lin

Tao

et al. 2014

PLoS ONE

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“…Trials comparing intravenous patient controlled analgesia using remifentanil with epidural analgesia suggest – which is not a surprise – a more pronounced reduction in pain scores with neuraxial analgesia [30,31]. When it comes to overall satisfaction with the analgesic technique, however, the studies report that “Maternal satisfaction was similar” [31] or “Patient satisfaction scores during and after delivery were similar in both groups” [32]. …”

Section: Discussionmentioning

confidence: 99%

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Kranke

Girard

Lavand’homme

et al. 2013

BMC Pregnancy Childbirth

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BackgroundThe epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units.Since the end of the 90ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don’t want, can’t have or don’t need epidural analgesia.DiscussionIn view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions.However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a “poor man’s epidural” and to safely administer remifentanil with an appropriate indication.SummaryTherefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia.

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Epidural versus non-epidural or no analgesia for pain management in labour

Anim‐Somuah

Smyth

Cyna

et al. 2018

Cochrane Database of Systematic Reviews

357

430

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Labour analgesia

Abstract: Remifentanil IVPCA and epidural provided effective analgesia, with high maternal satisfaction scores and reassuring neonatal outcome. Remifentanil produced more maternal sedation and oxygen desaturation. Close monitoring is, therefore, mandatory.

Cited by 54 publications

References 26 publications

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Epidural versus non-epidural or no analgesia for pain management in labour

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