A comparison of patient-controlled analgesia fentanyl and alfentanil for labour analgesia

Morley‐Forster, Patricia; Reid, Donald W.; Vandeberghe, Hilde

doi:10.1007/bf03018845

Cited by 54 publications

(29 citation statements)

References 18 publications

(17 reference statements)

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“…Despite this, the use of a low-dose background infusion has been described in some studies with no added maternal or neonatal benefits. 26,27,32 The major concern associated with IVPCA with opioids is the maternal and neonatal adverse effects. The incidence of maternal desaturation (SpO 2 \ 95%) has been shown to be 40-74% after remifentanil and up to 56% after fentanyl PCA.…”

Section: Discussionmentioning

confidence: 99%

“…28 The use of naloxone in up to 36% of cases has been described to overcome neonatal depression due to PCA fentanyl. 26 Naloxone is not used routinely at our institution unless respiratory depression is persistent. Since most neonates improved with resuscitative efforts, naloxone was not administered in any of our neonates.…”

Section: Discussionmentioning

confidence: 99%

“…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. Based on our previous studies, 15,29 a policy has been implemented at our institution in the last five years for the use of both remifentanil and fentanyl IVPCA for labour; however, the regimens differ from those reported in the study by Douma et al…”

Section: Résumémentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

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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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“…[14][15][16][17][18][19][20][21][22][23] Fentanyl has an onset of action within 30 sec, a peak effect in five to 15 min and a duration of action of 30 to 60 min. 4,14 In addition, fentanyl has no adverse effects on uterine tone or blood flow and is rapidly removed from the plasma with more than 80% removal within five minutes and more than 98% within an hour.…”

Section: Discussionmentioning

confidence: 99%

Patient-controlled analgesia with fentanyl provides effective analgesia for second trimester labour: a randomized controlled study

Castro

Tharmaratnam

Brockhurst

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine dose and lockout intervals for effective fentanyl patient-controlled analgesia (PCA) in second trimester genetic termination of pregnancy, and compare three different fentanyl PCA regimes with morphine PCA. M Me et th ho od ds s: :In a double-blind randomized study, 60 ASA physical status I-II patients received one of three fentanyl PCAs or morphine PCA. Labour was induced with prostaglandins and PCA use continued until delivery. Within two hours following delivery, four visual analogue scales (VAS) were administered measuring anticipated pain, pain relief in labour and delivery, and overall satisfaction. The drug delivery/demand ratio for two hours preceding delivery was obtained from the PCA pump. The outcome variables were analyzed using the Chi square test and analysis of variance as appropriate.R Re es su ul lt ts s: : The delivery/demand ratio was 0.71 ± 0.27 (mean ± standard deviation) for morphine; 0.67 ± 0.21 for fentanyl 50 µg, lockout six-minute; 0.63 ± 0.21 for fentanyl 25 µg, lockout threeminute; and 0.81 ± 0.17 for fentanyl 50 µg, lockout three-minute groups. We found no significant differences among the four groups with respect to using delivery/demand ratio as a measure of pain relief. Morphine had the highest rate of side effects compared to fentanyl. There was strong evidence of differences among groups with regard to patient satisfaction and expected pain, and moderate evidence of differences in the delivery and labour pain scores.C Co on nc cl lu us si io on n: : This study found PCA fentanyl 50 µg with a lockout period of six minutes provided satisfactory analgesia for second trimester labour. Objectif : Déterminer la dose et les périodes réfractaires d'une analgésie auto-contrôlée (AAC) efficace utilisée en cas d'interruption de grossesse génétique, et comparer trois régimes d'AAC avec fentanyl à la morphine en AAC. Méthode : Pendant l'étude randomisée et à double insu, 60 patientes d'état physique ASA I-II ont reçu l'un des trois régimes de fentanyl en AAC ou de la morphine en AAC. Le travail a été induit avec des prostaglandines et l'AAC continue a été utilisée jusqu'à l'accouchement. Pendant les deux premières heures après l'accouchement, la douleur attendue, le soulagement de la douleur du travail et de l'accouchement et la satisfaction générale ont été évalués grâce à quatre échelles visuelles analogiques (EVA). Pendant les deux heures précé-

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“…The progressive pattern of pain in labour is a challenge when the PID is calculated. For example, Morley-Forster et al (2000) noted that mean pain scores (VAS 0-100 mm) were 65 and 67 mm in groups receiving fentanyl and alfentanil, respectively via IVPCA, before the initiation of medications. During the treatment, the average pain scores were 65 and 86 mm (p < 0.01) at a 7 to 10 cm dilatation of the uterine cervix.…”

Section: Nature and Assessment Of Labour Painmentioning

confidence: 99%

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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A comparison of patient-controlled analgesia fentanyl and alfentanil for labour analgesia

Cited by 54 publications

References 18 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

Patient-controlled analgesia with fentanyl provides effective analgesia for second trimester labour: a randomized controlled study

Intravenous patient-controlled analgesia with remifentanil in early labour

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