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

Abstract

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

A prospective observational study of maternal oxygenation during remifentanil patient‐controlled analgesia use in labour

“…This supports recommendations to administer supplementary oxygen to all women using remifentanil PCA [13,15,17,18], but also reinforces the need for highquality protocols and midwifery training for remifentanil PCA.…”

“…We found that 70% of women underwent at least one desaturation episode when using remifentanil PCA. This is higher than incidences between 0% and 24% reported by other studies using the same threshold to define desaturation [8][9][10][11][12][13][14][15]. In these studies, oxygen saturation was recorded intermittently or relied upon study personnel to document desaturation episodes manually.…”

“…Ten hours of data were excluded from analysis on account of poor quality traces. Forty-three (70%) women had an oxygen desaturation episode; these women had a median (IQR [range]) of 3 (1-6 [1][2][3][4][5][6][7][8][9][10][11][12][13][14]) episodes each. All women who experienced a desaturation episode recovered spontaneously, with no woman receiving naloxone or requiring ventilatory or airway assistance.…”

The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature

“…Typically described is initial decrease in the intensity of labour pain during the first hour following remifentanil and then a return of pain intensity to initial values , even using a different application method and dose 14,15,29,31,32 . Despite this course, surprisingly few subsequent applications of epidural analgesia are described for inadequate pain relief using remifentanil (0-10%) which is hard to explain from the published data 28,29,[33][34][35] .…”

Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

“…En una serie de 23 neonatos no se observaron diferencias hemodinámicas ni en la saturación de oxígeno en las primeras 24 horas de vida tras recibir las madres una PCA de remifentanilo, aunque los autores describen durante la primera hora una tendencia a la hipotensión respecto a los neonatos cuyas madres no recibieron remifentanilo 83 . Comparado con la petidina, los resultados de los test neuroconductuales de los neonatos cuyas madres recibieron remifentanilo fueron mejores 66 y con el fentanilo, la incidencia de reanimación neonatal menor 84 . Las dosis usadas en la PCA varían de bolos de 0,15 a 0,5 μg/kg (rango 0,15 a 0,93 μg/kg) infundidos en 20 seg con intervalo de bloqueo de 1-3 min 85,86 .…”