Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour

Volikas, Ingrid; Butwick, Alexander J.; Wilkinson, Chris; Pleming, A.; Nicholson, Grainne

doi:10.1093/bja/aei219

Cited by 92 publications

(123 citation statements)

References 23 publications

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“…Our regimens for remifentanil and fentanyl were based on previous studies performed at our hospital that demonstrated effective analgesia with minimal maternal adverse effects. 15,29 Although remifentanil IVPCA has been used widely in the last decade for pain management during labour with 11,13,[15][16][17][18] or without background infusion, 6,12,14,[19][20][21] its most appropriate dosing regimen is still debated. Effective analgesia has been shown in studies that used infusions and escalating dose regimens titrated to individual patient requirements.…”

Section: Discussionmentioning

confidence: 99%

“…10 They found differences in the maternal pain scores only during the first hour and no differences in the neonatal outcome between the three groups. 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.…”

Section: Résumémentioning

confidence: 98%

“…Its context-sensitive half-time is about three minutes irrespective of its duration of infusion, 5 and the drug is quickly redistributed and metabolized in the fetus. 6,7 Fentanyl is also a short-acting synthetic opioid with a rapid onset of action (blood-effect site equilibration 6.4 min), but it exhibits cumulative effect with repeated or prolonged administration due to reuptake from inactive tissue sites, which leads to an increase in its context-sensitive halftime. 5,8 The elimination half-life in neonates varies from 75 to 440 min.…”

Section: Résumémentioning

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: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 98%

Section: Résumémentioning

confidence: 99%

See 1 more Smart Citation

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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“…Data concerning the consumption of remifentanil has been reported in 4 papers: Volikas et al (2005) and Evron et al (2008) reported a mean consumption of 0.12-0.14 μg/kg/min with IVPCA. Balcioglu et al (2005) reported a mean consumption of 0.25-0.27 µg/kg/min, while D' Onofrio et al (2009) noted the largest infusion rate used by parturients with a continuous median infusion of 0.075 µg/kg/min.…”

Section: Remifentanilmentioning

confidence: 99%

“…Volikas et al (2005) recorded hourly sedation during remifentanil analgesia on a 4-point scale (1 = alert, 2 =slightly drowsy but alert to voice, 3 = drowsy but responds to gentle stimulation, 4 = very drowsy) noting 22 out of 50 women being rated with score of 2 for ≥2h, but this was the highest recorded level of sedation. Blair et al (2001) used both subjective scoring with VAS (0-10) for sedation and observer scoring (1 = awake, 2 = drowsy, 3 = rousable to voice, who scored a sedation score of 2 (responds only after mild prodding and shaking) after a 0.5 µg/kg PCA bolus and a background infusion of 0.025 µg/kg/min.…”

Section: Sedationmentioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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Analgesia and Anesthesia for Pregnant Women with Inherited Bleeding Disorders

Bouthors

England

Kadir

2018

Inherited Bleeding Disorders in Women 2e

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Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour

Abstract: At the bolus dose used remifentanil PCA has an acceptable level of maternal side-effects and minimal effect on the neonate. Remifentanil crosses the placenta and appears to be either rapidly metabolized or redistributed in the neonate.

Cited by 92 publications

References 23 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 patient-controlled analgesia with remifentanil in early labour

Analgesia and Anesthesia for Pregnant Women with Inherited Bleeding Disorders

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