title: The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature.
abstract: OBJECTIVE
  Although epidural analgesia is still regarded as the gold standard for labour analgesia due to its efficacy, in cases of contraindication, systemic remifentanil is an alternative. Since the first demonstration of the safety of remifentanil in obstetric analgesia in 1996, this has been repeatedly confirmed for both mother and newborn. The aim of this meta-analysis is to evaluate recently published studies (up to December 2014) on the analgesic efficacy of remifentanil during labour (as a Visual Analogue Scale (VAS) decrease in the first hour by 2 or more).
  
  
  METHODS
  Search of the US National Library of Medicine, National Institutes of Health (www.pubmed.gov), SCOPUS database (www.scopus.com) and Web of Science database (www.webofknowledge.com) using the key words "labour" and "remifentanil". 44 identified articles were included in the review and 15 published randomised controlled studies were incorporated into the meta-analysis. This was based on the fixed model and described by differences in the VAS between t=0 and t=1 hour after remifentanil administration using the 95% confidence interval (CI). The analysis was computed using the Comprehensive meta-analysis version 2.2.064.
  
  
  RESULTS
  The combined data from the meta-analysis showed a statistically significant decrease in VAS in the remifentanil group. From a comparison of the CIs of summary estimates with a cut-off decrease of VAS 2, for the fixed model, there was a statistically significantly greater decrease in VAS than the cut-off. In the systematic review, we describe possible modes of application, dosage and side-effects for mother, fetus/ newborn.
  
  
  CONCLUSIONS
  The meta-analysis presented here confirms that remifentanil for labour analgesia is effective but questions remain which can only be answered by further randomized trials.
authors.affiliation: Department of Paediatric Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic.|Obstetric Anaesthesia and Analgesia Section of the Czech Society of Anaesthesiology and Intensive Care Medicine, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Stourac
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic.
authors.forename: Martina
authors.initials: M
authors.lastname: Kosinova
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Harazim
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Huser
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Janku
authors.affiliation: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Simona
authors.initials: S
authors.lastname: Littnerova
authors.affiliation: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
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; D004305:Dose-Response Relationship, Drug; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D048949:Labor Pain / Q000188:drug therapy; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D000077208:Remifentanil; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil
keywords: labour analgesia; meta-analysis; patient-controlled analgesia; remifentanil; systemic opioid analgesia