Remifentanil versus placebo for analgesia during external cephalic version: a randomised clinical trial

Muñoz, H.; Guerra, S.; Pérez-Vaquero, Pilar; Martinez, Cesar Valero; Aizpuru, Felipe; López-Picado, Amanda

doi:10.1016/j.ijoa.2013.07.006

Cited by 20 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings are consistent with other studies that have shown that remifentanil could reduce pain and increase maternal satisfaction. [13,14] However, our study found that remifentanil could also improve the success rate for ECV.…”

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

“…[13,14] One randomized controlled trial found no difference in the success rate for ECV between patients who received remifentanil with paracetamol and subjects who received placebo with paracetamol. [13] However, the mean pain score was significantly lower in the remifentanil group than in the control group. [13] Another randomized controlled trial also concluded that remifentanil analgesia decreased ECV-related pain, but failed to increase the success rate for ECV at term, and appeared to be associated with an increased frequency of mild AEs.…”

Section: Discussionmentioning

confidence: 99%

“…[13] However, the mean pain score was significantly lower in the remifentanil group than in the control group. [13] Another randomized controlled trial also concluded that remifentanil analgesia decreased ECV-related pain, but failed to increase the success rate for ECV at term, and appeared to be associated with an increased frequency of mild AEs. [14] …”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A randomized trial of remifentanil for analgesia in external cephalic version for breech presentation

Liu¹,

Xue

2016

Medicine

View full text Add to dashboard Cite

Background:Although external cephalic version (ECV) can be effective for correcting the fetus in a cephalic presentation, it may be painful for the mother. This study aimed to evaluate the efficacy and safety of remifentanil for pain relief during ECV in China.Methods:In all, 152 Chinese parturients with singleton breech presentation were randomly divided into 2 groups, each with 76 patients. All 152 patients were assigned to receive either remifentanil (infused at 0.1 μg/kg/min and demand boluses of 0.1 μg/kg) or saline placebo. The study was performed between January 2012 and December 2015. Outcome measurements included the Numerical Rating Pain Scale score (0–10) after ECV, success rate for ECV, and maternal satisfaction after ECV. Adverse events were also evaluated.Results:The study was completed by 146 patients. Remifentanil showed greater efficacy than placebo in decreasing the pain score immediately after ECV (remifentanil 4.6 ± 2.6 vs placebo 6.5 ± 2.7; P < 0.001). The success rate for ECV showed a significant difference between the 2 groups (remifentanil 56.5% vs placebo 39.5%; P = 0.04). Maternal satisfaction also showed a significant difference between the 2 groups (remifentanil 9.6 ± 1.4 vs placebo 6.4 ± 3.7; P < 0.001). However, the adverse events profiles were similar between both groups.Conclusion:The results of this study demonstrate that remifentanil is an effective intervention for reducing pain, achieving successful ECV, and increasing maternal satisfaction during ECV, and is generally well-tolerated without additional adverse effects.

show abstract

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A randomized trial of remifentanil for analgesia in external cephalic version for breech presentation

Liu¹,

Xue

2016

Medicine

View full text Add to dashboard Cite

show abstract

“…[5] Although previous studies have used neuraxial analgesia for ECV, [10,11,12] which has been associated with improved pain scores and increased success of ECV, those drugs may also be associated with maternal hypotension, sedation, and other adverse events (AEs). [13,14] Cluver and colleagues conducted a Cochrane systematic review and found that use of regional analgesia did not produce a corresponding decrease in the cesarean rate, [6] although it can increase the success rate of ECV. [6] In addition, regional analgesia may also have significant adverse effects.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Yang

2017

Medicine

View full text Add to dashboard Cite

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.

show abstract

Interventions for helping to turn term breech babies to head first presentation when using external cephalic version

Cluver

Hofmeyr

Gyte

et al. 2012

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Breech presentation is associated with increased complications. Turning a breech baby to head first presentation using external cephalic version (ECV) attempts to reduce the chances of breech presentation at birth, and reduce the adverse effects of breech vaginal birth or caesarean section. Tocolytic drugs and other methods have been used in an attempt to facilitate ECV. Objectives To assess interventions such as tocolysis, fetal acoustic stimulation, regional analgesia, transabdominal amnioinfusion or systemic opioids on ECV for a breech baby at term. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 September 2011) and the reference lists of identified studies. Selection criteria Randomised and quasi-randomised trials comparing the above interventions with no intervention or other methods to facilitate ECV at term. Data collection and analysis We assessed eligibility and trial quality. Two review authors independently assessed for inclusion all potential studies identified as a result of the search strategy and independently extracted the data using a designed data extraction form. Main results We included 25 studies, providing data on 2548 women. We used the random-effects model for pooling data due to clinical heterogeneity in the included studies in the various comparisons. The overall quality of the evidence was reasonable, but a number of assessments had insufficient data to provide an answer with any degree of assurance. Tocolytic drugs, in particular betastimulants, were effective in increasing cephalic presentations in labour (average risk ratio (RR) 1.38, 95% confidence interval (CI) 1.03 to 1.85, eight studies, 993 women) and in reducing the number of caesarean sections (average RR 0.82, 95% CI 0.71 to 0.94, eight studies, 1177 women). No differences were identified in fetal bradycardias (average RR 0.95, 95% CI 0.48 to 1.89, three studies, 467 women) although the review is underpowered for assessing this outcome. We identified no difference in success, cephalic presentation in labour and caesarean sections between nulliparous and multiparous women. There were insufficient data comparing different groups of tocolytic drugs. Sensitivity analyses by study quality agreed with the overall findings. Regional analgesia in combination with a tocolytic was more effective than the tocolytic alone in terms of increasing successful versions (assessed by the rate of failed ECVs, average RR 0.67, 95% CI 0.51 to 0.89, six studies, 550 women) but there was no difference identified in cephalic presentation in labour (average RR 1.63, 95% CI 0.75 to 3.53, three studies, 279 women) nor in caesarean sections (average RR 0.74, 95% CI 0.40 to 1.37, three studies, 279 women) or fetal bradycardia (average RR 1.48, 95% CI 0.62 to 3.57, two studies, 210 women). There were insufficient data on the use of vibroacoustic stimulation, amnioinfusion or systemic opioids. Authors’ conclusions Betastimulants, to facilitate ECV, increased cephalic presentation in labour...

show abstract

Remifentanil versus placebo for analgesia during external cephalic version: a randomised clinical trial

Cited by 20 publications

References 29 publications

A randomized trial of remifentanil for analgesia in external cephalic version for breech presentation

A randomized trial of remifentanil for analgesia in external cephalic version for breech presentation

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

Interventions for helping to turn term breech babies to head first presentation when using external cephalic version

Contact Info

Product

Resources

About