Assessement of patient-controlled analgesia using remifentanil as an effective and safe alternative to patient-controlled epiduralúanalgesia for labour

ABSTRACT

This study compared the administration of intravenous infusion of remifentanil using patient-controlled analgesia [PCA] device for analgesia in normal labour with that of 0.1% bupivacaine plus sufentanil 0.5 microg/ml via patient-controlled epidural analgesia [PCEA]. One hundred healthy pregnant women at term with a single fetus with a vertex fetal presentation were divided in two equal groups to receive either 0.25 microg to 1 microg/kg as bolus dose of remifentanil PCA in a stepwise manner with or without a background infusion [0.025-0.05 microg/kg] or 0.1% bupivacaine and 0.5 microg/ml sufentanil using PCEA. Pain Score on visual analog score [VAS]. Modified bromage scale [0-3]. Level of sensory block, drug use, supplemental boluses and side effects were recorded. Mode of delivery, duration of first and second stages of labour, umblical cord pH, Apger scores of the newborn and a measure of maternal satisfaction were recorded after delivery. VAS pain score during the progress of labour was significantly less in bupivacaine group PCEA [16.9 +/- 13.4mm] compared with the lowest pain scores in remifentanil group recorded at L[1]B[1] bolus 0.25 microg/kg [30.2 +/- 23 mm] and at L[1]B[2] bolus 0.5 microg/kg [24.4 +/- 18 mm] respectively, P<0.01, Maternal satisfaction with the relief of contraction pain was greater in bupivacaine group [90.8 +/- 10.8] than in remifentail group L[1]B[1] 70.20 +/- 20 mm, L[1]B[2] 50.2 +/- 12.8] P<0.0001, as with the relief of delivery pain [bupivacaine group 88.7 +/- 14.1 mm, L[1]B[1] 78.3 +/- 2.3 mm, L[1]B[2] 80.1 +/- 25.2 mm] P < 0.0001. On visual scale 0 = not satisfied, 100 = fully satisfied. Motor and sensory block were assessed with the progress of labour in bupivacaine group. No differences were seen between the two groups for mode of delivery, maternal blood pressure, fetal heart rate, apger score 0, 5, 10 min and umblical pH. Patients in remifentanil group requested more supplemental boluses to achieve labour analgesia than those in bupivacaine group, adding background infusion at level two or three bolus doses not reduce pain scores but serves only to increase respiratory depression, sedation and opioid side effects [vomiting, nausea and itching]. Delivered as patient-controlled epidural analgesia 0.1% bupivacaine plus 0.5 microg/ml sufentanil are more potent than PCA remifentanil. Remifentanil PCA system [bolus doses 0.25-0.5 microg/kg without a background infusion] may safely provide worthwhile, although incomplete analgesia for labour