Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour

Thurlow, J. A.; Laxton, C.; Dick, A. T.; Waterhouse, P.; Sherman, L.; Goodman, Neville W.

doi:10.1093/bja/88.3.374

Cited by 101 publications

(97 citation statements)

References 15 publications

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“…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.…”

Section: Discussionsupporting

confidence: 65%

“…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. 1,9,[25][26][27][28] Therefore further research is needed to ensure the safety of these drugs while used for IVPCA in labouring women.…”

Section: Résumémentioning

confidence: 97%

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

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

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Purpose We undertook a retrospective study to compare the analgesic efficacy and effects on neonatal outcome of administering either remifentanil or fentanyl intravenous patient-controlled analgesia (IVPCA) during labour. Methods A five-year retrospective cohort study was undertaken of women with more than 24 weeks of gestation who had received either IVPCA remifentanil or fentanyl for labour analgesia at Mount Sinai Hospital. The sampling timeframe was from November 2005 to March 2010. The standard IVPCA regimen for the remifentanil group consisted of a PCA bolus 0.25 lgÁkg -1 with a lockout interval of two minutes, a four-hour limit of 3 mg, and a background infusion of 0.025-0.05 lgÁkg -1 Ámin -1 , whereas the standard IVPCA regimen for the fentanyl group consisted of a PCA bolus 25-50 lg with a lockout interval of three to six minutes and a four-hour limit of 1-1.5 mg. The following data were compared: maternal hourly pain scores (verbal pain score scale 0-10), sedation scores (scale 0-3), adverse effects, and neonatal outcomes. Mixed linear modelling was used to analyze longitudinal data on pain scores over time. The exact Wilcoxon test and the Fisher's exact test were used for other comparisons.Results Ninety-eight women were studied. There was no significant difference in the model-adjusted pain scores between the two groups (P = 0.86). There was a moderate decrease in pain scores in both groups compared with the baseline values. There was no difference in maternal side effects between the two groups, although transient oxygen desaturation was observed more frequently in the remifentanil group than in the fentanyl group (13% vs 2%, respectively; odds ratio, 7.32; 95% confidence interval [CI], 0.85 to 63.3). A larger number of neonates in the fentanyl group required resuscitation compared with neonates in the remifentanil group (59% vs 25%, respectively; odds ratio, 4.33; 95% CI, 1.75 to 10.76); adjusted (44% vs 8%, respectively; odds ratio, 8.56; 95% CI, 2.17 to 33

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Section: Discussionsupporting

confidence: 65%

Section: Résumémentioning

confidence: 97%

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

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

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“…Hypoxaemia has been noted in many studies concerning remifentanil labour analgesia (table 3). Remifentanil analgesia was not different from pethidine in three comparative studies (Volikas et al 2001, Thurlow et al 2002, Blair et al 2005, but 50% nitrous oxide in oxygen was used by a large proportion of the parturients in all three of these studies. In a study without the potentially interfering effect of inhaled nitrous oxide in oxygen, Evron et al (2005) noted a better SaO 2 with remifentanil at all time points (after 1 hour of analgesia, at the end of the 1 st and 2 nd stages of labour).…”

Section: Respiratory Effectsmentioning

confidence: 86%

“…Other researchers noted no differences in the sedation scores between remifentanil and pethidine using the subjective VAS and an observer scale (Blair et al 2005, Thurlow et al 2002.…”

Section: Sedationmentioning

confidence: 94%

“…None of the four studies comparing remifentanil and pethidine analgesia observed a significant difference in nausea and vomiting between the two medications. In the study by Thurlow et al (2002), however, pethidine was accompanied with a prophylactic antiemetic. In spite of this, there was a trend towards more nausea in the pethidine group.…”

Section: Nausea and Vomitingmentioning

confidence: 97%

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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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Parenteral opioids for maternal pain management in labour

Ullman

Smith

Burns

et al. 2010

Cochrane Database of Systematic Reviews

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Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour

Abstract: In this pilot study, remifentanil by PCA gave better pain relief to mothers in labour than intramuscular meperidine. However, remifentanil is a potent respiratory depressant and adequate continuous monitoring is necessary.

Cited by 101 publications

References 15 publications

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

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

Intravenous patient-controlled analgesia with remifentanil in early labour

Parenteral opioids for maternal pain management in labour

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