title: Perinatal outcomes: intravenous patient-controlled fentanyl versus no analgesia in labor.
abstract: OBJECTIVE
  To investigate perinatal outcomes, the analgesic efficacy and maternal satisfaction in nulliparous women receiving fentanyl intravenous patient-controlled analgesia (i.v.-PCA).
  
  
  METHODS
  A total of 1401 nulliparous women with a singleton pregnancy who received fentanyl i.v.-PCA (i.v.-PCA group, n = 290) or no analgesia (control group, n = 1111) in labor between 2005 and 2010 were reviewed. Fentanyl i.v.-PCA was implemented on maternal request during the first stage of labor over 35 weeks of gestation, and discontinued at full cervical dilatation. Perinatal outcomes were compared between the i.v.-PCA and the control groups. The numerical rating scale (NRS) levels during labor were also examined in the i.v.-PCA group. Additionally, parturients received fentanyl i.v.-PCA in 2010 (n = 73) were asked about overall satisfaction using a scale poor, moderate, good and excellent on postpartum day 0-3.
  
  
  RESULTS
  Women receiving i.v.-PCA showed significantly longer labor and more need of oxytocin augmentation, compared with the control. Cesarean section was significantly less frequent in the i.v.-PCA group compared with the control (11.0% v.s. 24.1%, respectively), with the vacuum-assisted delivery rate comparable between groups. Neonatal outcomes (i.e. Apgar score <7 at 1 min or 5 min, umbilical artery pH <7.20) were comparable between groups, irrespective of mode of delivery. Significant reduction of NRS levels was noted until 3 h after induction of i.v.-PCA, compared to the baseline. Of the women who expressed their satisfaction, 72% (48/67) exhibited 'excellent' or 'good' for pain relief by i.v.-PCA.
  
  
  CONCLUSIONS
  Fentanyl i.v.-PCA could be a useful approach for labor pain relief in nulliparas when regional blocks are unavailable.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan. kei@z7.keio.jp
authors.forename: Kei
authors.initials: K
authors.lastname: Miyakoshi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morisaki
authors.forename: Seon-Hye
authors.initials: SH
authors.lastname: Kim
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hosokawa
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Minegishi
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007564:Japan; D017060:Patient Satisfaction; D011247:Pregnancy; D012189:Retrospective Studies; D047929:Term Birth
chemical_list: D018686:Anesthetics, Intravenous; D005283:Fentanyl