title: A double-blind randomised comparison of intravenous patient-controlled remifentanil with intramuscular pethidine for labour analgesia.
abstract: In a prospective, double-blind, randomised controlled trial, we compared the efficacy of patient-controlled analgesia using remifentanil (25-30 μg per bolus) with intramuscular pethidine (50-75 mg) for labour analgesia in 69 parturients. Parturients receiving patient-controlled analgesia reported less pain than those receiving intramuscular pethidine throughout the study period (p < 0.001), with maximal reduction in visual analogue pain score at 2 h after commencement of analgesia (mean (SD) 20 (17) in the patient-controlled analgesia group and 36 (22) in the intramuscular pethidine group. The median (95% CI) time to the first request for rescue analgesics was significantly longer with patient-controlled analgesia (8.0 (6.8-9.2) h) compared with intramuscular pethidine (4.9 (3.8-5.4) h, p < 0.001). Maternal satisfaction scores were also higher with remifentanil compared with intramuscular pethidine (p= 0.001). There was no report of sedation, aponea or oxygen desaturation in either group, and Apgar scores were similar between groups. We conclude that patient-controlled analgesia with remifentanil provides better labour analgesia and maternal satisfaction than intramuscular pethidine. At this dose, maternal and fetal side effects were uncommon.
authors.affiliation: Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong SAR. tonyktng@gmail.com
authors.forename: T K T
authors.initials: TK
authors.lastname: Ng
authors.forename: B C P
authors.initials: BC
authors.lastname: Cheng
authors.forename: W S
authors.initials: WS
authors.lastname: Chan
authors.forename: K K
authors.initials: KK
authors.lastname: Lam
authors.forename: M T V
authors.initials: MT
authors.lastname: Chan
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008614:Meperidine / Q000008:administration & dosage*; D010880:Piperidines / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D008614:Meperidine; D000077208:Remifentanil