Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials

Lee, Myeong-Jong; Zhu, Fang; Moodie, Jessica; Zhang, Zhe; Cheng, Davy; Martin, Janet

doi:10.1016/j.jclinane.2017.03.026

Cited by 34 publications

(26 citation statements)

References 34 publications

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“…Many studies have shown that remifentanil (an off label drug for parturient) has less adverse neonatal or maternal effects during cesarean section; thus, they have suggested its use as a replacement for standard opioids in cesarean section [8][9][10] . In our clinic, we found that continuous intravenous infusion of low-dose remifentanil has a good rescue analgesic effect on incomplete epidural analgesia and provides a degree of sedation during cesarean section, which improves the patient experience.…”

Section: Introductionmentioning

confidence: 99%

Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

Wei

Xiong

Yao

et al. 2019

Preprint

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Background: Unsatisfactory analgesia would occur frequently during repeated cesarean section under epidural anesthesia. The aim of this study is to observe the effects of intravenous remifentanil on maternal comfort, maternal and neonatal safety during repeated cesarean section under epidural anesthesia.Methods: A total of 80 parturients undergoing repeated cesarean section were involved in the study. The patients were randomly divided into the intravenous remifentanil- assisted epidural group (group R) and epidural group (group E), respectively (n=40). In group R, the remifentanil was continuously intravenously infused as an adjuvant to epidural anesthesia. In group E, 0.75% ropivacaine epidural or intravenous ketamine was administered as needed. Parturient baseline characteristics, vital signs, VAS scores, and comfort scores during surgery were recorded. Adverse effects were also recorded.Results: A total of 80 patients were enrolled in the current study and the final analyses included 39 patients in group R and 38 patients in group E. No differences in patients’ baseline characteristics were found between the two groups (p > 0.05). Compared with group E, the comfort score was significantly higher in group R (9.1±1.0 vs. 7.5±1.3, p<0.001), whereas the maximum VAS score was significantly lower in group R (1.8±1.2 vs. 4.1±1.0, p<0.001). Maternal and neonatal adverse effects did not differ between the two groups during surgery (p>0.05).Conclusions: Continuous intravenous infusion of low-dose remifentanil can significantly improve the experience of parturients undergoing repeated cesarean section under epidural anesthesia, without noticeable maternal or neonatal adverse effects.

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Section: Introductionmentioning

confidence: 99%

Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

Wei

Xiong

Yao

et al. 2019

Preprint

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“…Recently, alternative opioids, such as fentanyl or remifentanil, have become favored in the obstetrical setting because their short‐acting characteristic and rapid metabolism can provide quick effects and minimize neonatal respiratory depression through placental transfer of the agents . In particular, it was reported in a meta‐analysis that patient‐controlled analgesia (PCA) with remifentanil could provide maternal satisfaction comparable to epidural analgesia …”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of a combination of pethidine and levallorphan for pain relief during labor: An observational study

Kinugasa¹,

Miyake²,

Tamai³

et al. 2018

J of Obstet and Gynaecol

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Aim: To evaluate the safety, effect on breastfeeding and efficacy of a combination of pethidine and levallorphan (Pethilorfan) for pain relief during labor. Methods: We compared maternal or neonatal morbidities, suckling difficulties in newborns and breastfeeding rates between 177 women who received 50-200 mg (as pethidine) of Pethilorfan during labor (Pethilorfan group) and 354 women who delivered their infants without analgesic drugs immediately before or after each woman in the Pethilorfan group (control group) from January 1, 2005 to December 31, 2016. We performed univariate and multivariate analyses for comparison between the two groups. We also evaluated the efficacy of Pethilorfan retrospectively. Results: The Pethilorfan group included more women with prolonged and/or operative deliveries than the control group. Nevertheless, no significant differences were seen between the two groups in the rates of Apgar scores less than 7 at 1 or 5 min, composite neonatal morbidities, hyperbilirubinemia or respiratory disturbances. The incidence of suckling difficulties lasting over 24 h and the breastfeeding rates at discharge or after 1 month were also similar. Maternal adverse effects of Pethilorfan were generally mild and transient. The efficacy ratio of Pethilorfan was 83.6%, although its analgesic effect was usually incomplete. Conclusion: Pethilorfan can be used safely for labor pain relief without increasing maternal or neonatal morbidities, or impeding breastfeeding, if it is administered at a prudent dosage. Parenteral opioids including Pethilorfan should remain as an option for treating women in labor pain, particularly when epidural analgesia is not readily available or contraindicated.

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“…Intravenous RPCA is shown to be an alternative to pain relief during labor [18]. Currently, there is no review aimed at assessing the risk of an intrapartum maternal fever between patients receiving RPCA and those receiving EA.…”

Section: Introductionmentioning

confidence: 99%

Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis

Yao

Chen

et al. 2020

BMC Pregnancy Childbirth

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Background: Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was performed by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from inception to April 2019. All randomized controlled trials (RCTs) investigating the risk of intrapartum maternal fever with RPCA compared with EA alone or EA in combination with spinal analgesia during labor were included. Results: A total of 825 studies were screened, and 6 RCTs including 3341 patients were identified. Compared with EA, RPCA was associated with a significantly lower incidence of intrapartum maternal fever (risk ratio [RR] 0.48, P = 0.02, I 2 = 49%) during labor analgesia. After excluding 2 trials via the heterogeneity analysis, there was no difference in the incidence of intrapartum fever between patients receiving RPCA and those receiving EA. Satisfaction with pain relief during labor was lower in the RPCA group than that in the EA group (− 10.6 [13.87, − 7.44], P < 0.00001, I 2 = 0%). The incidence of respiratory depression was significantly greater in the RPCA group than that in the EA group (risk ratio 2.86 [1.65, 4.96], P = 0.0002, I 2 = 58%). The incidence of Apgar scores < 7 at 5 min in the RPCA group was equivalent to that in the EA group. Conclusion: There is no solid evidence to illustrate that the incidence of intrapartum maternal fever is lower in patients receiving intravenous RPCA than in patients receiving EA.

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Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials

Cited by 34 publications

References 34 publications

Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

Safety and efficacy of a combination of pethidine and levallorphan for pain relief during labor: An observational study

Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis

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