Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010–2015)

Melber, Andrea; Jelting, Yvonne; Huber, Matthew; Keller, Douglas A.; Dullenkopf, Alexander; Girard, Thierry; Kranke, Peter

doi:10.1016/j.ijoa.2018.12.004

Cited by 36 publications

(34 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study reconfirmed the well-known risk of respiratory adverse events associated with RPCA [12]. A similar desaturation rate was also reported by others using threshold and dosage ranges similar to ours [5,15]. Nevertheless, after implementing a lower dose range regimen (10-30 µg), a decrease in desaturation rate was observed on account of worse pain scores and a lower satisfaction rate.…”

Section: Discussionsupporting

confidence: 91%

“…It should be noted that this observation does not in itself imply a lack of efficacy, since pain scores are known to increase during labour [14]. Similar pain relief with remifentanil has been observed by other researchers whose bolus dosages used were similar to ours [5,8,15]. In contrast, Tveit et al, whose mean bolus doses ranged from 0.30-1.05 μg kg -1 , obtained much lower pain scores (3.8 ±1.7) 60 min after the onset of analgesia on account of severe sedation and increase rate of desaturation.…”

Section: Discussionsupporting

confidence: 85%

“…Nevertheless, after implementing a lower dose range regimen (10-30 µg), a decrease in desaturation rate was observed on account of worse pain scores and a lower satisfaction rate. [15,23]. Weiniger et al also noticed episodes of apnoea which could not be reliably predicted [9].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Remifentanil versus combined spinal-epidural technique for labour analgesia in multiparous women: a prospective non-randomized trial

Pintarič¹,

Zagar²,

Semrl³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background : Remifentanil has a suitable pharmacological profile for labour analgesia. Fast set up, onset, and limited time efficacy may render it useful in multiparas with a faster labour progression. The objective of this prospective, non-randomized trial was to compare the pain relief for vaginal delivery between remifentanil patient-controlled analgesia (RPCA) with that of combined spinal-epidural analgesia (CSEA) in multiparas. Methods : After making an informed choice of either RPCA or CSEA, 162 multiparous women in the active phase of first-stage labour were enrolled in this study. The primary outcome was pain intensity measured during the whole period of labour using an 11-point numerical rating scale. The secondary outcomes were satisfaction with pain-relief, adverse effects, labour progress and outcomes. Results : CSEA provided lower pain scores and a higher satisfaction rate than RPCA [3.9 (0.36) vs 2.6 (1.1), P <0.001]. Also, more patients opted for the CSEA for their next labour [CSEA; 77 (95%) vs. RPCA; 65 (81%), P =0.003]. However, more than 80% of women in the RPCA group graded their satisfaction as good and very good with a high rate of recommendation and no crossovers observed. Remifentanil was associated with desaturation, bradypnea and apnoea in 27 (34%), 17 (21%) and 20 (25%) respective cases. All recovered spontaneously upon verbal or tactile stimulation. No clinically important differences were noted in sedation level, labour progress and outcomes. Conclusions : CSEA provided superior pain relief compared to RPCA in multiparas. Despite that, remifentanil was highly rated, with a high rate of recommendation and no crossovers to CSEA. That can be attributed to the fact that women with previewed shorter labour were more likely to choose a less invasive analgesic option which provided an element of personal control. Thus, given no difference in labour outcomes, remifentanil could be offered as a routine analgesic option provided rigorous adherence to the necessary protocols are ensured. The presence of a midwife is essential for timely management of respiratory depression or other severe outcomes.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Remifentanil versus combined spinal-epidural technique for labour analgesia in multiparous women: a prospective non-randomized trial

Pintarič¹,

Zagar²,

Semrl³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Whilst remifentanil is an off label drug for parturients and some serious adverse effects with remifentanil have been reported previously, it has been recently said that remifentanil is effective, has less adverse effects compared to other opioid medications and is safe to use in controlled circumstances [8–10]. 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

Yan

Xiong

et al. 2019

BMC Anesthesiol

View full text Add to dashboard Cite

BackgroundUnsatisfactory 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.MethodsA 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.ResultsA 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).ConclusionsContinuous 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.Trial registrationThis study was pre-registered at http://www.chictr.org.cn/index.aspx (ChiCTR1800018423) on 17/09/2018.

show abstract

“…The RemiPCA SAFE Network has been established to set standards and monitor maternal and fetal outcomes when remifentanil is used for labour analgesia. 10…”

Section: Pharmacological Techniquesmentioning

confidence: 99%

Labour analgesia: update and literature review

2020

View full text Add to dashboard Cite

Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We review the most recent evidence on the efficacy and safety of these techniques. Over the past decade, the availability of safer local anaesthetics, ultra-short acting opioids, combined spinal-epidural needles, patient-controlled analgesic devices, and ultrasound have revolutionised obstetric regional analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique, as it leads to higher maternal satisfaction and good maternal and fetal safety profiles. We examine the controversies and myths concerning the initiation, maintenance, and discontinuation of epidural

show abstract

Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010–2015)

Cited by 36 publications

References 14 publications

Remifentanil versus combined spinal-epidural technique for labour analgesia in multiparous women: a prospective non-randomized trial

Remifentanil versus combined spinal-epidural technique for labour analgesia in multiparous women: a prospective non-randomized trial

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

Labour analgesia: update and literature review

Contact Info

Product

Resources

About