title: Remifentanil for labour analgesia:  a meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Remifentanil is a potent short-acting μ-opioid receptor agonist which is rapidly metabolised in the mother and fetus and may be ideal for labour analgesia.
  
  
  OBJECTIVE
  To assess efficacy and safety of remifentanil compared with other analgesic techniques for labour pain.
  
  
  METHODS
  We systematically searched the central register of controlled trials of the Cochrane Library (till August 2011) and MEDLINE (till August 2011).
  
  
  METHODS
  Randomised controlled trials investigating efficacy and safety of remifentanil administered via a patient-controlled analgesia (PCA) device compared with any other analgesic technique for labour pain were included.
  
  
  RESULTS
  We finally included 12 randomised controlled trials (published from 2001 to 2011). Women treated with remifentanil had a lower risk of conversion to epidural analgesia (P < 0.001), a lower mean pain score after 1 h (P < 0.001) and had higher satisfaction scores (P < 0.05) in comparison with women receiving pethidine. Epidural analgesia decreased pain scores compared with remifentanil (P = 0.003). There was only a limited amount of data comparing remifentanil with nitrous oxide or fentanyl. Serious maternal or fetal adverse outcomes were not reported in these trials.
  
  
  CONCLUSIONS
  During labour, remifentanil-PCA provided superior analgesia and higher patient satisfaction compared with pethidine with a comparable degree of adverse events. Epidural analgesia provided superior pain relief in comparison with remifentanil. Due to a low number of reported adverse events, the safety issue of remifentanil use in labour remains an open question that needs to be addressed in future trials.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital of Münster, Oberdürrbacher Street 6, Münster, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schnabel
authors.forename: Niklas
authors.initials: N
authors.lastname: Hahn
authors.forename: Jens
authors.initials: J
authors.lastname: Broscheit
authors.forename: Ralf M
authors.initials: RM
authors.lastname: Muellenbach
authors.forename: Lorenz
authors.initials: L
authors.lastname: Rieger
authors.forename: Norbert
authors.initials: N
authors.lastname: Roewer
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods; D016362:Analgesia, Obstetrical / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil