title: Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia: a randomised equivalence trial.
abstract: OBJECTIVE
  To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women.
  
  
  METHODS
  Randomised controlled equivalence trial.
  
  
  METHODS
  Eighteen midwifery practices and six hospitals in the Netherlands.
  
  
  METHODS
  A total of 408 pregnant women at low risk for obstetric complications initially under the care of primary-care midwives.
  
  
  METHODS
  Women randomised before active labour to receive analgesia with RPCA or EA, if requested.
  
  
  METHODS
  Primary outcome was satisfaction with pain relief measured hourly using a visual analogue scale and summed as area under the curve (AUC). Secondary outcomes were overall satisfaction with pain relief, pain intensity scores during labour, mode of delivery, and maternal and neonatal outcomes.
  
  
  RESULTS
  We randomised 418 women, of whom 409 could be followed for the primary endpoint. Analgesia was received by 46% (94/203) in the remifentanil group and 37% (76/206) in the epidural group. The AUC for satisfaction with pain relief was 32 in the remifentanil group and 31 in the epidural group (mean difference -0.50; 95% CI -6.8 to 5.9). Among women who actually received analgesia, these values were 23 and 35, respectively (mean difference -12; 95% CI -22 to -1.5). Secondary outcomes were comparable.
  
  
  CONCLUSIONS
  In low-risk labouring women, we could not demonstrate equivalence between a strategy with RPCA to EA with respect to satisfaction with pain relief assessed during the total duration of labour. However, once applied satisfaction was higher in women who received epidural analgesia.
  
  
  CONCLUSIONS
  Satisfaction with pain relief is higher in women receiving epidural analgesia compared with Remifentanil PCA.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Slm
authors.initials: S
authors.lastname: Logtenberg
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Oude Rengerink
authors.affiliation: Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.|Maxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Verhoeven
authors.affiliation: Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Freeman
authors.affiliation: Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Esa
authors.initials: E
authors.lastname: van den Akker
authors.affiliation: Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: M B
authors.initials: MB
authors.lastname: Godfried
authors.affiliation: Department of Obstetrics and Gynaecology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van Beek
authors.affiliation: Department of Anaesthesiology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Owhm
authors.initials: O
authors.lastname: Borchert
authors.affiliation: Department of Obstetrics and Gynaecology, Diakonessen Hospital, Utrecht, the Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Schuitemaker
authors.affiliation: Department of Anaesthesiology, Diakonessen Hospital, Utrecht, the Netherlands.
authors.forename: Ecsm
authors.initials: E
authors.lastname: van Woerkens
authors.affiliation: Midwifery Practice Alnatal, Nieuwegein, the Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Hostijn
authors.affiliation: Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: van der Post
authors.affiliation: The Robinson Research Institute School of Medicine, University of Adelaide and The South Australian Health and Medical Research Institute Adelaide Australia, Adelaide, SA, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019540:Area Under Curve; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D007743:Labor, Obstetric; D009426:Netherlands; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D000077208:Remifentanil / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000077208:Remifentanil
keywords: Epidural analgesia; labour pain; pain intensity score; pain satisfaction score; remifentanil patient-controlled analgesia; satisfaction with pain relief