title: Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour.
abstract: BACKGROUND
  Remifentanil has been suggested as an ideal opioid for patient-controlled analgesia (PCA) in labour, but the safety profile has not been established. The aims of this preliminary prospective observational study were to investigate the maternal side-effects and early neonatal effects, and to assess the placental transfer of remifentanil PCA during labour.
  
  
  METHODS
  Women with no known obstetric complications or contraindication to remifentanil were recruited (n=50). Remifentanil was administered at a bolus dose of 0.5 microg kg(-1) and a lockout period of 2 min. A visual analogue scale was used to assess pain, nausea and itching. Maternal observations were recorded hourly and fetal heart rate trace was assessed every 2 h. Umbilical cord gases, 1 and 5 min Apgar scores and neurological evaluation of the neonate were recorded. Maternal venous blood and umbilical artery and vein cord blood samples were collected for analysis of remifentanil concentration.
  
  
  RESULTS
  Fifty women enrolled in the study (24 multiparous, 26 primiparous). There was no evidence of cardiovascular instability or respiratory depression. Pain scores decreased significantly, but there was no significant change in nausea after initiating the PCA. A statistically significant increase in itching was found to be clinically mild and 22 women were slightly drowsy (95% confidence interval [CI], 30-58.7%) but alert to voice. Ten fetal heart rate traces demonstrated changes in the first 20 min, but did not require intervention (95% CI, 10-33.7%). The median 1 and 5 min Apgar scores were 9. The mean umbilical cord gases and neurological examination were within normal limits. Maternal vein and umbilical vein cord samples demonstrated placental transfer of remifentanil, and small amounts were detected in umbilical artery samples.
  
  
  CONCLUSIONS
  At the bolus dose used remifentanil PCA has an acceptable level of maternal side-effects and minimal effect on the neonate. Remifentanil crosses the placenta and appears to be either rapidly metabolized or redistributed in the neonate.
authors.affiliation: Department of Anaesthesia, St Helier Hospital, Surrey, UK. ivolikas@hotmail.com
authors.forename: I
authors.initials: I
authors.lastname: Volikas
authors.forename: A
authors.initials: A
authors.lastname: Butwick
authors.forename: C
authors.initials: C
authors.lastname: Wilkinson
authors.forename: A
authors.initials: A
authors.lastname: Pleming
authors.forename: G
authors.initials: G
authors.lastname: Nicholson
mesh_terms: D000293:Adolescent; D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000097:blood; D001034:Apgar Score; D005260:Female; D005318:Fetal Heart / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D009325:Nausea / Q000139:chemically induced; D010880:Piperidines / Q000009:adverse effects* / Q000097:blood; D011247:Pregnancy; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil