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

Abstract

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.

The efficacy and safety of remifentanil patient-controlled versus epidural analgesia in labor: A meta-analysis and systematic review

“…In theory, the mode of PCA can make the blood concentration of remifentanil synchronize with the uterine contractions [31]. Some studies [32][33][34] have shown that selfcontrolled intravenous administration of remifentanil can effectively relieve uterine contraction pain, and compound background doses can reduce the number of compressions, improve analgesia satisfaction, have little effect on the labor process, and do not increase the rate of cesarean section.…”

SP22.1 Remifentanil PCIA has no place in labor analgesia

“…In 2020, Lu et al reported a significantly higher risk of respiratory depression with Remifentanil PCIA as compared to epidural analgesia (RR: 2.86 (1.65-4.96), p= 0.0002). (22) In 2021, Zhang et al reported also an increased risk of maternal oxygen desaturation with Remifentanil PCIA as compared to epidural analgesia (RR= 3.23, 95% CI 1.98-5.30). 18 In addition, several case reports have described respiratory arrest and cardiac arrest in patients using Remifentanil PCIA for labor analgesia.…”

“…32 In another 2017 randomized trial, Logtenberg et al did not find any difference in the incidence of maternal fever between Remifentail PCIA (10%) and epidural analgesia (8%) 33 In a 2020 meta-analysis including 6 randomized controlled trial and 3341 patients, Lu et al concluded that there is no solid evidence to illustrate that intrapartum maternal fever is lower with Remifentanil PCIA than with epidural analgesia. 22 Risks of decreasing epidural rate An increased use of alternative analgesia such as Remifentanil PCIA might carry the risk of an increased use of general anesthesia for intrapartum cesarean section or other obstetrical indications. This is particularly true for high-risk parturients such as patients undergoing a trial of labor after C-Section, obese patients and preeclamptic patients for whom epidural analgesia is strongly recommended.…”

Application of virtual reality technology combined with moderate perineal protection in natural childbirth

“…Due to the severe pain caused by the regular contraction of the uterus and the long labour process, many pregnant women are afraid of natural delivery. It is reported that labour pain can cause maternal sympathetic excitement and increase the release of catecholamines in the body, which inhibits uterine contraction, prolongs the labour process, causes an acid-base imbalance, decreases uterine blood flow and causes fetal distress [20][21][22]. For pregnant women, especially primiparas, childbirth pain causes strong psychological and physiological stress responses, resulting in slower expansion of the uterine orifice and a prolonged labour process, which makes it difficult to deliver smoothly [23].…”