Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour

Abstract

The efficacy of meperidine, fentanyl, and remifentanil PCA for labour analgesia varied from mild to moderate. Remifentanil PCA provided better analgesia than meperidine and fentanyl PCA, but only during the first hour of treatment. In all groups, pain scores returned to pre-treatment values within 3 h after the initiation of treatment.

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

“…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.…”

“…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.…”

“…The standard deviation for differences in verbal pain scores was estimated as 2.9 cm from the Douma trial. 10 …”

“…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.…”

“…9 A randomized controlled trial by Douma et al has compared IVPCA with remifentanil, fentanyl, and meperidine for labour analgesia. 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.…”