Remifentanil by patient controlled analgesia compared with epidural analgesia for pain relief in labour

ABSTRACT

Epidural analgesia has been established as the gold standard for labour analgesia. However, clinical contraindications and personnel or institutional limitations preclude some parturients from receiving an epidural. Remifentanil has been suggested as an ideal opioid for patient controlled analgesia [PCA] in labour. In our study we compared the use of PCA remifentanil to epidural analgesia in labour as regard pain relief, safety of the mother and the fetus, side effects, and overall parturient's satisfaction. After ethical committee approval and informed written consent 30 healthy pregnant women ASA I or II, with no obstetric complications or contraindication to remifentanil or epidural analgesia were included in the study randomly allocated into one of two equal groups, in [Group EP] epidural infusion of bupivacain 1% plus 2 micro g/ml of fentanyl was given and in [Group R] the women received PCA remifentanil with a bolus of 0.4 micro g kg[-1] over 20 seconds and a lockout period of 1 min as an analgesia for labour. There was significant decrease in [VAS] of pain in both groups with significantly more decrease in [Group EP]. There were no significant difference between both groups as regard arterial blood pressure, heart rate, oxygen saturation, nausea, and overall patient's satisfaction. Sedation scores were significantly higher in [Group R], there were no serious bradycardia, hypotension, or desaturation, and all the parturients were easily arousable. There were no fetal heart rate changes that required interference. The median 1 and 5 minutes Apgar scores were 9 in both groups, and the mean umbilical cord gases, and lactate levels were within normal limits with no difference between both groups. Our study demonstrated that epidural infusion gives superior analgesia for labour than PCA remifentanil, however PCA remifentanil is a good, safe, and could be an alternative method of analgesia for labour