title: Comparison of parturient - controlled remifentanil with epidural bupivacain and sufentanil for labour analgesia: randomised controlled trial.
abstract: BACKGROUND
  Epidural analgesia (EA) has significant contraindications including coagulation disorders and parturient refusal. One alternative is intravenous self-administered analgesia using the ultra short-acting opioid remifentanil (rPCA). We compared the efficiency and safety of standard epidural analgesia with parturient-controlled intravenous analgesia using remifentanil as well as personal satisfaction.
  
  
  METHODS
  We enrolled twelve ASA I classified women with singleton pregnancy who delivered vaginally in the period 3/2010-5/2010 and who received rPCA (n=12) in standard analgesic protocol: 20 µg boluses using PCA pump with a lockout interval of 3 min. The control group consisted of 12 pregnant women who received EA (n=12): 0.125% bupivacaine with sufentanil 0.5 µg/mL in top-up boluses every hour until delivery. Data were acquired from standard Acute Pain Service (APS) form and patient medical records (demographic, labour course parameters), Visual Analogue Scale (VAS), Bromage Scale (BS) and adverse effects of analgesia.
  
  
  RESULTS
  There were no demographic or labour course parameter differences between groups (P>0.05). The differences in VAS decrease (P=0.056) and parturient satisfaction (P=0.24) during the whole analgesia administration were statistically insignificant. The main limitation of the study was small sample and enrolment of healthy singleton pregnant women only.
  
  
  CONCLUSIONS
  Remifentanil use in obstetric analgesia is a viable alternative to EA, especially in cases of EA contraindications and parturient disapproval.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty Hospital Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Stourac
authors.forename: Hana
authors.initials: H
authors.lastname: Suchomelova
authors.forename: Marta
authors.initials: M
authors.lastname: Stodulkova
authors.forename: Martin
authors.initials: M
authors.lastname: Huser
authors.forename: Ivo
authors.initials: I
authors.lastname: Krikava
authors.forename: Petr
authors.initials: P
authors.lastname: Janku
authors.forename: Olga
authors.initials: O
authors.lastname: Haklova
authors.forename: Lubomir
authors.initials: L
authors.lastname: Hakl
authors.forename: Roman
authors.initials: R
authors.lastname: Stoudek
authors.forename: Roman
authors.initials: R
authors.lastname: Gal
authors.forename: Pavel
authors.initials: P
authors.lastname: Sevcik
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D036801:Parturition; D010880:Piperidines / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D000077208:Remifentanil; D017409:Sufentanil / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010880:Piperidines; D017409:Sufentanil; D000077208:Remifentanil; D002045:Bupivacaine