A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour.

Author(s): Douma MR, Middeldorp JM, Verwey RA, Dahan A, Stienstra R

Affiliation(s): Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. M.R.Douma@lumc.nl

Publication date & source: 2011-04, Int J Obstet Anesth., 20(2):118-23. Epub 2011 Mar 3.

Publication type: Comparative Study; Randomized Controlled Trial

BACKGROUND: The mu-opioid agonist remifentanil has a rapid onset and offset and a short half-life making it an attractive option for intravenous patient-controlled labour analgesia. We aimed to compare the efficacy of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour. METHODS: Parturients were randomly assigned to receive intravenous patient-controlled analgesia with remifentanil (n=10) or epidural analgesia (n=10). Pain and satisfaction scores were assessed every hour by means of visual analogue scale, together with an observer sedation score. Side effects and neonatal outcome were noted. RESULTS: After one hour, visual analogue pain scores had decreased significantly in both groups (remifentanil: -3.8 +/- 2.6, P<0.01; epidural -6.7 +/- 2.0, P<0.01). The decrease in pain scores in the epidural group was significantly greater than the remifentanil group at all time intervals. The decrease in pain scores was sustained in the epidural group whereas in the remifentanil group pain scores increased over time. Oxygen saturation was significantly lower in the remifentanil group after one hour of treatment compared to the epidural group (95.2 +/- 2.4% vs. 99.0 +/- 1.1%, P<0.01). Patient satisfaction scores during and after delivery were similar in both groups. No differences were found in neonatal outcome. CONCLUSIONS: In the 20 patients recruited to this study, pain relief in labour with epidural ropivacaine/sufentanil was more effective than with intravenous remifentanil patient-controlled analgesia. Copyright (c) 2010 Elsevier Ltd. All rights reserved.