Patient‐controlled epidural analgesia in labor does not always improve maternal satisfaction

Nikkola, Eeva; Läärä, Arja; Hinkka, Susanna; Ekblad, Ulla; Kero, Pentti; Salonen, Markku

doi:10.1080/00016340500409935

Cited by 23 publications

(18 citation statements)

References 25 publications

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“…Maternal analgesia satisfaction was higher (90% reported good/excellent) in Group B (with 2 μg/ml fentanyl group) than in Group A (1 μg/ml fentanyl) showing a 60% satisfied level which was merely 40% in Group C. This difference was found to be clinically significant when measured by a 100-mm VAS and VPS. [2425]…”

Section: Discussionmentioning

confidence: 99%

A double-blind study on analgesic effects of fentanyl combined with bupivacaine for extradural labor analgesia

et al. 2011

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Background:The intermittent technique of labor extradural analgesia has been showing promising results over other techniques. This study was done to assess and compare the efficacy of two different doses of fentanyl mixed with low doses of bupivacaine in intermittent labor extradural analgesia.Materials and Methods:90 ASA grade I-II parturients in active labor with a cervical dilatation of 3–7 cm were randomly allocated to three different groups: Group A: 10 ml bupivacaine 0.125% + fentanyl 10 μg (1 μg/ml)Group B: 10 ml bupivacaine 0.125% + fentanyl 20 μg (2 μg/ml)Group C: 10 ml bupivacaine 0.125% (the control group) All patients were preloaded with 10-15 ml/kg Lactated Ringer's solution. Labor analgesia was maintained by intermittent boluses of the drug combination.Results:The mean time of the onset of analgesia was significantly lower (P<0.05) and the duration of analgesia was significantly higher (P<0.01) in Group B when compared with Groups A and C (P<0.001). Patient satisfaction was considerably better in Group B (P<0.01). However, in both groups, the progression of labor was found to be slightly more prolonged than Group C. The level of the sensory and motor block was comparable in both the groups and was at the T8–T10 level; it was comparable and the level of motor blockade (Bromage score = 0, 1) in each group was also not significant (P>0.05).Conclusion:The addition of fentanyl (2 μg/ml) to bupivacaine 0.125% decreases the time of the onset of analgesia and increases the duration of analgesia and level of maternal satisfaction during labor as compared to fentanyl (1 μg/ml).

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Section: Discussionmentioning

confidence: 99%

A double-blind study on analgesic effects of fentanyl combined with bupivacaine for extradural labor analgesia

et al. 2011

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“…Introduction of the PCA principle in the EDA did not increase the feeling of being in control of analgesia or increase satisfaction with analgesia in the study by Nikkola et al (2006).…”

Section: Nature and Assessment Of Labour Painmentioning

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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Section: Maternal Satisfactionmentioning

confidence: 99%

“…3,5,58 This multidimensional issue is therefore challenging to evaluate and measure, both in research and daily clinical practice. 58 Previous studies have used many different methods and approaches for measurement, making it difficult to compare the results. 150 The degree of pain relief is the main subject for most parturients, although other factors could influence satisfaction too; thus personal expectations, amount of support from caregivers, the quality of the caregiver-patient relationship, and involment in decision making have been demonstrated as key factors for maternal satisfaction.…”

Section: Maternal Satisfactionmentioning

confidence: 99%

“…With epidural solutions containing low-dose local anesthetics combined with opioids, this problem is reduced ('mobile epidural'). 4,64 Potential maternal side effects include hemodynamic instability and pruritus, as well as nausea/vomiting, urinary retention, respiratory depression, 3,4,58,[71][72][73][74] and impaired breast feeding. 4,47,52,70,[75][76][77] Epidural associated fever is still discussed, but so far without evidence.…”

Section: Regional Analgesiamentioning

confidence: 99%

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Remifentanil as analgesia for labour pain

Tveit

2013

Acta Anaesthesiol Scand

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Background To collect updated information about pharmacological labour analgesia in Norway, especially systemic opioids and epidural. Evaluation of efficacy and safety with remifentanil intravenous patient‐controlled analgesia (IVPCA) for pain relief during labour. To compare remifentanil IVPCA with epidural analgesia (EDA) regarding efficacy and safety during labour. Methods In paper I, two national surveys identified Norwegian labour analgesia methods and changes during the study period (2005–2008). Paper II is a prospective, observational study of analgesic efficacy and safety with remifentanil IVPCA. Paper III is a prospective, randomized controlled trial comparing remifentanil IVPCA with EDA regarding analgesic efficacy and safety. Results The surveys in paper I found the frequency of EDA in Norwegian hospitals to be increasing, but still low (25.9%) compared with other western countries. Nitrous oxide and traditional systemic opioids, like pethidine, were frequently used. In paper II, remifentanil IVPCA was found to give satisfactory labour analgesia in more than 90% of the parturients with an average maximal pain reduction of 60%. Maternal oxygen desaturation and sedation were acceptable, and neonatal data reassuring. In paper III, a randomized controlled trial found remifentanil IVPCA and EDA to be comparable both regarding analgesic efficacy (pain reduction; Fig. ) and maternal satisfaction. Remifentanil IVPCA produced more maternal sedation and oxygen desaturation; neonatal outcome was reassuring in both groups. Reduction in pain score [visual analogue scale (VAS)] during labour analgesia with patient‐controlled intravenous remifentanil and continuous epidural infusion with ropivacaine and fentanyl. Conclusion The frequency of epidural labour analgesia in Norway has increased, but is still relatively low. Nitrous oxide and traditional systemic opioids are frequently used. The clinical practice seems conservative; newer short‐acting opioids are seldom used for systemic labour analgesia. The studies on remifentanil IVPCA revealed adequate pain relief, high maternal satisfaction, and no serious neonatal side effects. There were no differences in analgesic efficacy, maternal satisfaction, and neonatal outcome when comparing remifentanil IVPCA with EDA. However, remifentanil caused maternal sedation and oxygen desaturation. We recommend the use of IVPCA remifentanil as labour analgesia instead of traditional opioids as pethidine and morphine when EDA is not an option. The presence of skilled personnel and close monitoring is mandatory.

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Patient‐controlled epidural analgesia in labor does not always improve maternal satisfaction

Abstract: We found no advantages for patient-controlled epidural analgesia over intermittent bolus epidural analgesia in terms of maternal satisfaction.

Cited by 23 publications

References 25 publications

A double-blind study on analgesic effects of fentanyl combined with bupivacaine for extradural labor analgesia

A double-blind study on analgesic effects of fentanyl combined with bupivacaine for extradural labor analgesia

Intravenous patient-controlled analgesia with remifentanil in early labour

Remifentanil as analgesia for labour pain

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