Remifentanil in obstetric analgesia: a dose-finding study.
IV patient-controlled analgesia (PCA) with remifentanil is a new approach in systemic opioid analgesia during labor. We determined the minimum effective dose of IV remifentanil by increasing the PCA bolus from 0.2 microg/kg with 0.2 microg/kg increments during a 60-min study period until the analgesia was considered adequate by the parturient. Twenty healthy parturients with singleton pregnancies participated in the study during the first stage of labor. Remifentanil hydrochloride was given IV via PCA over 1 min with a lockout time of 1 min. The parturient started the PCA bolus at the first subjective sign of uterine contraction. All 17 patients who completed the study reached adequate pain relief. The median effective PCA bolus was 0.4 microg/kg and consumption was 0.066 microg x kg(-1) x min(-1), with wide individual variation (0.2-0.8 microg/kg and 0.027-0.207 microg x kg(-1) x min(-1), respectively). The pain scores were reduced by a median of 4.2 (25th-75th percentiles, 3.1-5.2; P < 0.001) on an 11-point numeric scale. Although there was a wide individual variation in the dose required, remifentanil seems effective for labor analgesia. However, maternal oxygen desaturation, sedation, and reduced fetal heart rate beat-to-beat variability were observed frequently. There was wide individual variation in the dose required for effective labor analgesia. Potentially serious side effects, which were observed frequently during remifentanil analgesia, may limit remifentanil's use in obstetrics.


CONCLUSIONS
We determined the minimum effective dose of patient-controlled IV remifentanil for labor analgesia. There was wide individual variation in the dose required for effective labor analgesia. Potentially serious side effects, which were observed frequently during remifentanil analgesia, may limit its use in obstetrics.
Volmanen
Petri
P
Lapland Central Hospital, Rovaniemi, Finland. petri.volmanen@lshp.fi
Akural
Ethem I
EI
Raudaskoski
Tytti
T
Alahuhta
Seppo
S
D000328:Adult; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001034:Apgar Score; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D000077208:Remifentanil
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil; D010100:Oxygen