A Preliminary Investigation of Remifentanil as a Labor Analgesic

Dhileepan, S.; Stacey, R. G. W.

doi:10.1097/00000539-200105000-00062

Cited by 33 publications

(6 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our regimens for remifentanil and fentanyl were based on previous studies performed at our hospital that demonstrated effective analgesia with minimal maternal adverse effects. 15,29 Although remifentanil IVPCA has been used widely in the last decade for pain management during labour with 11,13,[15][16][17][18] or without background infusion, 6,12,14,[19][20][21] its most appropriate dosing regimen is still debated. Effective analgesia has been shown in studies that used infusions and escalating dose regimens titrated to individual patient requirements.…”

Section: Discussionmentioning

confidence: 99%

“…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%

See 1 more Smart Citation

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

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…The inevitable delay and slow administration of the bolus led to the study being abandoned due to lack of efficacy. In more recent studies, authors have commented that training of the parturient in bolus timing is desirable [17].…”

Section: Optimal Dosing Regimementioning

confidence: 99%

“…This compares well to a study [20] that included women in labour with no analgesia in which 46% of women desaturated below 90% for between 30 s and 6 min per hour during the second stage of labour. In an audit [17] from my own institution of over 100 women using PCA remifentanil for labour analgesia, 10% exhibited desaturation that required supplementation with nasal oxygen.…”

Section: Maternal and Neonatal Adverse Effectsmentioning

confidence: 99%

Remifentanil in obstetrics

Hill

2008

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…Extremely wide ranges of effective dosages of remifentanil in labour have been reported, varying between parturients and within the same parturient during labour itself as it progressed. Many authors have searched for an ideal dosing regimen [3–14] and timing [15] of remifentanil delivery. Usually, a combination of continuous background infusion and boluses on request has been used, but there are also reports in which only one of these options was chosen [2, 4, 11, 15–17].…”

mentioning

confidence: 99%

Modified patient‐controlled remifentanil bolus delivery regimen for labour pain*

2012

View full text Add to dashboard Cite

SummaryTo improve the analgesic efficiency and to simplify the administration of remifentanil for systemic analgesia in labour, we contrived a modified delivery regimen with a specific infusion profile and variable dosing and conducted a single-blind randomised crossover study to compare it with the previous 'classical' regimen. Parturients received both regimens in interchangeable sets, each with five contractions. We compared pain and satisfaction scores, maternal and fetal vital parameters, side-effects and other events. Twenty-three parturients completed the study. No differences in observed parameters were noticed except for slightly lower blood pressure with the modified regimen. Pain estimates were lower in women starting with the modified regimen (p = 0.005), and there were fewer requests for analgesia within the lockout period (31 vs 69, p = 0.041) and bolus adjustments (0 vs 25, p < 0.001) with the modified regimen.

show abstract

A Preliminary Investigation of Remifentanil as a Labor Analgesic

Cited by 33 publications

References 4 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

Remifentanil in obstetrics

Modified patient‐controlled remifentanil bolus delivery regimen for labour pain*

Contact Info

Product

Resources

About