Patient-controlled intravenous analgesia remifentanil for labor analgesia

Velde, Marc Van de

doi:10.1097/aco.0000000000000191

Cited by 19 publications

(9 citation statements)

References 17 publications

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“…Five other systematic reviews with or without meta‐analysis dealing with remifentanil for labour analgesia have been published up to March 2016 . In summary, the previous reviews revealed similar effects of interventions (direction of estimated effects).…”

Section: Discussionmentioning

confidence: 83%

Patient‐controlled analgesia with remifentanil vs. alternative parenteral methods for pain management in labour: a Cochrane systematic review

et al. 2017

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SummaryWe aimed to assess the effectiveness of remifentanil used as intravenous patient-controlled analgesia for the pain of labour. We performed a systematic literature search in December 2015 (updated in December 2016). We included randomised, controlled and cluster-randomised trials of women in labour with planned vaginal delivery receiving patient-controlled remifentanil compared principally with other parenteral and patient-controlled opioids, epidural analgesia and continuous remifentanil infusion or placebo. The primary outcomes were patient satisfaction with pain relief and the occurrence of adverse events for mothers and newborns. We assessed risk of bias for each included study and applied the GRADE approach for the quality of evidence. We included total zero event trials, using a constant continuity correction of 0.01 and a random-effect meta-analysis. Twenty studies were included in the qualitative analysis; within these, 3713 participants were randomised and 3569 analysed. Most of our pre-specified outcomes were not studied in the included trials. However, we found evidence that women using patient-controlled remifentanil were more satisfied with pain relief than women receiving parenteral opioids (four trials, 216 patients, very low quality evidence) with a standardised mean difference ([SMD] 95%CI) of 2.11 (0.72-3.49), but were less satisfied than women receiving epidural analgesia (seven trials, 2135 patients, very low quality evidence), À0.22 (À0.40 to À0.04). Data on adverse events were sparse. However, the relative risk (95%CI) for maternal respiratory depression for patient-controlled remifentanil compared with epidural analgesia (three trials, 687 patients, low-quality evidence) was 0.91 (0.51-1.62). Compared with continuous intravenous infusion of remifentanil (two trials, 135 patients, lowquality evidence) no conclusion could be reached as all study arms showed zero events. The relative risk (95%CI) of Apgar scores less than 7 at 5 min after birth compared with epidural analgesia (five trials, 1322 participants, lowquality evidence) was 1.26 (0.62-2.57).

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Section: Discussionmentioning

confidence: 83%

Patient‐controlled analgesia with remifentanil vs. alternative parenteral methods for pain management in labour: a Cochrane systematic review

et al. 2017

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“…As the author mentions, instant intervention to ensure ventilation is needed in such cases, and, similarly, in cases of hypoventilation caused by remifentanil. The major difference is that in the case of remifentanil, hypoventilation usually subsides after several dozen seconds, whereas complications of regional analgesia -respiratory depression and circulatory disorders -generally last slightly longer [10]. Such situations are not even mentioned by the author.…”

Section: In Reply To the Commentary To Commentary To "Remifentanil Fomentioning

confidence: 86%

In reply to the commentary to Commentary to "Remifentanil for labour pain relief"

Sołek-Pastuszka

Zagrodnik-Ułan²,

Bohatyrewicz³

et al. 2016

Anaesthesiol Intensive Ther

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“…23 24 As a consequence, several editorials and review articles have been published to raise awareness of this risk of maternal respiratory depression and to challenge the validity of Remifentanil PCIA for labor analgesia. [25][26][27][28] By contrast, several cohort studies aimed to be reassuring. In a 2019 retrospective analysis, Melber AA et al reported the results of a 6 years audit (2010-2015) of the outcome data of the RemiPCA SAFE network.…”

Section: Discussionmentioning

confidence: 99%

SP22.1 Remifentanil PCIA has no place in labor analgesia

Dewandre¹

2022

Invited Speakers

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usually feasible for an epidural catheter to be re-inserted in an emergency. It also requires the anaesthesiologist to explain this additional procedure to the patient and gain informed consent in a challenging situation. This extra workload i.e., explaining, gaining informed consent, and inserting a spinal anaesthetic, may be stressful for the anaesthesiologist. Also, they are now required to perform a procedure in a time-pressured and high-stakes environment. Performance anxiety may also play a part if the anaesthesiologist is very keen to avoid a general anaesthetic, for example, if they feel the patient's airway looks particularly difficult or the patient has pre-eclampsia and would therefore be at a higher risk of complications.Patient perspectives should also be considered. The author has found no published literature specifically relating to patient preference regarding epidural or spinal anaesthesia for emergency Caesarean section. However, it is reasonable to think that a patient who has a working labour epidural already has confidence in the technique and as a result, may feel more reassured with epidural anaesthesia for emergency Caesarean section as compared to alternatives.In summary, labour epidurals providing satisfactory analgesia should be considered for a top up to provide epidural anaesthesia for emergency Caesarean sections. In fact, this is one of the main benefits of siting labour epidurals in patients who are at a higher risk for Caesarean section and is a strong feature of obstetric anaesthesia practice using the principles of Planning, Preparation and Pre-emption. In addition, there are disadvantages to the alternative of removing the labour epidural and using a spinal anaesthetic. Furthermore, there are cost, environmental, anaesthesiologist, and patient considerations that may support the choice of epidural anaesthesia over spinal. REFERENCES1. National Institute for Health and Care Excellence (Great Britain). Intrapartum care for women with existing medical conditions or obstetric complications and their babies.

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Patient-controlled intravenous analgesia remifentanil for labor analgesia

Cited by 19 publications

References 17 publications

Patient‐controlled analgesia with remifentanil vs. alternative parenteral methods for pain management in labour: a Cochrane systematic review

Patient‐controlled analgesia with remifentanil vs. alternative parenteral methods for pain management in labour: a Cochrane systematic review

In reply to the commentary to Commentary to "Remifentanil for labour pain relief"

SP22.1 Remifentanil PCIA has no place in labor analgesia

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