Remifentanil for labour analgesia

Schnabel, Alexander; Hahn, N; Broscheit, Jens; Muellenbach, Ralf Michael; Rieger, Lorenz; Roewer, Norbert; Kranke, Peter

doi:10.1097/eja.0b013e32834fc260

Cited by 136 publications

(19 citation statements)

References 36 publications

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“…The cumulative evidence suggests that compared with pethidine, its use for labour analgesia is associated with significantly improved pain relief and satisfaction and is associated with a significantly decreased conversion rate to epidural analgesia [30]. Trials comparing intravenous patient controlled analgesia using remifentanil with epidural analgesia suggest – which is not a surprise – a more pronounced reduction in pain scores with neuraxial analgesia [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Trials comparing intravenous patient controlled analgesia using remifentanil with epidural analgesia suggest – which is not a surprise – a more pronounced reduction in pain scores with neuraxial analgesia [30,31]. When it comes to overall satisfaction with the analgesic technique, however, the studies report that “Maternal satisfaction was similar” [31] or “Patient satisfaction scores during and after delivery were similar in both groups” [32].…”

Section: Discussionmentioning

confidence: 99%

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Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Kranke

Girard

Lavand’homme

et al. 2013

BMC Pregnancy Childbirth

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BackgroundThe epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units.Since the end of the 90ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don’t want, can’t have or don’t need epidural analgesia.DiscussionIn view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions.However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a “poor man’s epidural” and to safely administer remifentanil with an appropriate indication.SummaryTherefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Kranke

Girard

Lavand’homme

et al. 2013

BMC Pregnancy Childbirth

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“…Fentanyl was avoided to prevent further pulmonary compromise in the premature fetus, and since other options were available and deemed safe for both the mother and fetus, those were utilized, rather than performing a cardiac induction with high dose opioids. However, another option that has been shown to be efficacious and safe for both a cardiac parturient and her fetus is the use of Remifentanil, which has been used as a low dose patient-controlled analgesia (PCA) infusion for many laboring women who cannot have neuraxial analgesia during labor [18][19][20][21][22][23] . Short-acting opioid infusions have been proven to be safe for the patient, with minimal effects on the fetus, supposing the parturient can tolerate the hemodynamic effects of such an anesthetic approach [3] .…”

Section: Discussionmentioning

confidence: 99%

The Anesthetic Management of a Pre-Term Parturient Undergoing Urgent Cesarean Delivery for Fetal Complications within 30 Days of Drug-Eluting Stent Placement: A Case Report and Literature Review

Anthony¹,

Gittens²,

Chaudhry³

et al. 2018

JAS

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Cardiomyopathy in pregnancy is a prevalent disease we encounter as obstetric anesthesiologists, and can be a major cause of maternal perinatal morbidity and mortality if not appropriately managed, particularly during the antepartum period [1]. The gold standard of care remains neuraxial anesthesia with adequate labor analgesia and vaginal delivery if feasible [2]. However, this technique is not always appropriate as women may present with contraindications to neuraxial anesthesia, such as women on anticoagulation. This is particularly noted in women who have known cardiac disease, as women who undergo coronary interventions prior to labor are managed with chemical anticoagulation. General anesthetic consideration for this population takes into account not only cardiac techniques but the implications on fetal wellbeing [2]. Although maternal outcomes remain our priority as the safety of the mother is necessary for fetal survival, improving fetal status at birth is ideal. In this particular paper, we discuss the challenges we faced in a parturient who underwent percutaneous coronary intervention during her pregnancy, and required urgent cesarean section within 30 days of receiving a drug-eluting stent. We present the literature surrounding these concerns and the options available to anesthesiologists to provide safe anesthesia for both mother and fetus. Objectives The purpose of this manuscript is to discuss the proper evaluation of the parturient with cardiac disease, to provide an overview of the literature, and to properly formulate a safe obstetric and labor plan in women with confirmed cardiomyopathy.

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“…[5] Their study found that the mean pain scores measured with the visual analog scale (VAS) ranged from 4.6 to 8.5 of the maximum of 10. [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.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Yang

2017

Medicine

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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.

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Remifentanil for labour analgesia

Cited by 136 publications

References 36 publications

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

The Anesthetic Management of a Pre-Term Parturient Undergoing Urgent Cesarean Delivery for Fetal Complications within 30 Days of Drug-Eluting Stent Placement: A Case Report and Literature Review

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

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