Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term

Abstract

Background:The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term.Methods:A total of 144 nulliparous women with singleton breech presentation were randomly divided into the intervention group and the placebo group, with 72 subjects in each group. The subjects in the intervention group received remifentanil (infused at 0.1 μg kg–1 min–1 with demand boluses of 0.1 μg/kg), whereas those in the placebo group were given saline placebo. This study was conducted from May 2013 to April 2016. The outcomes measures include pain (measured with the visual analog scale, VAS), success rate of ECV, maternal satisfaction for ECV, and adverse events.Results:A total of 137 participants completed the study. The intervention with remifentanil showed greater efficacy than did placebo in decreasing the VAS score immediately after ECV (intervention group 4.3 ± 2.2 vs placebo group 6.4 ± 2.5, P < 0.01). A significant difference in the ECV success rate was also found between the 2 groups (intervention group 56.9% vs placebo group 38.9%, P = 0.03). In addition, a significant difference in the satisfaction score was also detected (intervention group 9.3 ± 0.9 vs placebo group 6.7 ± 1.2, P < 0.01). The observed adverse events were similar between the 2 groups.Conclusion:This study shows that remifentanil could decrease pain, improve the ECV success rate, and improve satisfaction in nulliparous women at term during the period of ECV. Furthermore, it is also well tolerated with few adverse events.

Efficacy and safety of remifentanil for analgesia in cesarean delivery

“…[ 7 , 8 ] However, it can also be eliminated from fetal circulation at the time of delivery. [ 9 ] It is often be used for external cephalic version intervention, [ 10 , 11 ] surgery, [ 12 – 14 ] and propofol injection. [ 15 , 16 ]…”

A randomised controlled trial to assess the feasibility of utilising virtual reality to facilitate analgesia during external cephalic version

“…Indeed, ECV is a procedure associated with a moderate degree of pain 4,[6][7][8] . This was exemplified by a study which demonstrated median pain scores of 5.7 (IQR 2.7-6.8) in women undergoing ECV on a 10-point visual analogue scale 8 .…”

Is Propofol a safe agent for External Cephalic Version?

“…To the best of our knowledge, no report using propofol has been published. It should be highlighted that intravenous analgesia with remifentanil [17][18][19] has reported a lower ECV success rate (56.9%, 51.7%, 49% respectively) than propofol sedation which is used in this report. Burgos et al 18 advised that although remifentanil did not increase the ECV success rate, the pain related to the procedure was markedly reduced.…”