Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double-blinded study.
BACKGROUND
We hypothesised that intravenous patient-controlled analgesia (IV PCA) with remifentanil could provide as satisfactory pain relief for labour as epidural analgesia.


METHODS
Fifty-two parturients with singleton uncomplicated pregnancies were randomised to receive either IV PCA with remifentanil or epidural analgesia with 20 ml levobupivacaine 0.625 mg/ml and fentanyl 2 microg/ml in saline. The PCA dose of remifentanil was given over 1 min with a lockout time of 1 min. The dose was increased starting from the bolus of 0.1 microg/kg and following a dose escalation scheme up until the individual-effective dose was reached. The parturients assessed contraction pain (0-10), pain relief (0-4), sedation and nausea during 60 min.


RESULTS
Forty-five parturients were included in the analysis. The median cervical opening was 4 cm before the study and 7 cm after the study. The median pain scores were 7.3 and 5.2 during remifentanil and epidural analgesia, respectively (P=0.009). The median pain relief scores were 2.5 and 2.8 (P=0.17). There was no difference between the groups in the proportion of parturients who discontinued due to ineffective analgesia, nor in the proportion of parturients who would have liked to continue the given medication at the end of the study. Sedation and low haemoglobin oxygen saturation were observed more often during remifentanil analgesia. Foetal heart rate tracing abnormalities were as common in both groups.


CONCLUSIONS
In terms of pain scores, epidural analgesia is superior to that provided by IV remifentanil. However, there was no difference in the pain relief scores between the treatments.
Volmanen
P
P
Lapland Central Hospital, Rovaniemi, Finland. petri.volmanen@lshp.fi
Sarvela
J
J
Akural
E I
EI
Raudaskoski
T
T
Korttila
K
K
Alahuhta
S
S
D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D000077554:Levobupivacaine; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D000077208:Remifentanil; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D010880:Piperidines; D000077554:Levobupivacaine; D000077208:Remifentanil; D005283:Fentanyl; D002045:Bupivacaine