Safety and efficacy of remifentanil patient-controlled analgesia versus epidural analgesia in labor

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Abstract

Background

Epiduralanalgesia is considered to be the preferred method of analgesia during labor. Systemic opioids are also a good, effective, and easy to administer alternative but may cause maternal and fetal respiratory depression. Remifentanil has rapid onset and offset effects, making it an ideal drug for the management of intermittent painful contractions during labor. Thus, this study aimed to confirm that remifentanil patient-controlled analgesia (PCA) is as effective as epidural analgesia as regards analgesic quality and patient satisfaction, with no or little side effects during labor.

Methods

A total of 90 pregnant women were randomly assigned to one of two groups with equal number of participants in each group. In the remifentanil group, PCA was set up to deliver a loading dose of 30 μg remifentanil and 30 μg bolus with a 3-min lockout time. The dose can be increased to 40 μg or decreased to 20 μg; the women were advised to start the PCA bolus when they felt the signs of an upcoming uterine contraction. The epidural group received epidural analgesia according to a standardized protocol using bupivacaine plus fentanyl.

Results

All women showed a significant decrease in visual analog scale scores in the first hour after administration of analgesia (P<0.05). Analgesic quality in terms of the visual analog pain score, sedation score, and postdelivery patient satisfaction in both groups was comparable (P>0.05). PCA remifentanil infusion until the time of delivery produced no observable maternal, fetal, or neonatal side effects (P<0.05).

Conclusion

Intravenous PCA with remifentanil is an effective option for pain relief with minimal maternal and neonatal side effects, lower costs, and easier achievement of pain relief during labor.

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