A Randomized Controlled Trial of the Efficacy and Respiratory Effects of Patient-Controlled Intravenous Remifentanil Analgesia and Patient-Controlled Epidural Analgesia in Laboring Women

@article{Stocki2014ARC,
  title={A Randomized Controlled Trial of the Efficacy and Respiratory Effects of Patient-Controlled Intravenous Remifentanil Analgesia and Patient-Controlled Epidural Analgesia in Laboring Women},
  author={Daniel Stocki and Idit Matot and Sharon Einav and Smadar Eventov-Friedman and Yehuda Ginosar and Carolyn F. Weiniger},
  journal={Anesthesia \& Analgesia},
  year={2014},
  volume={118},
  pages={589–597}
}
BACKGROUND:Safe and effective alternatives are required in labor when epidural analgesia is not appropriate. We hypothesized that patient-controlled IV remifentanil labor analgesia would not be inferior to patient-controlled epidural labor analgesia. METHODS:This randomized nonblinded controlled noninferiority study in healthy women with a singleton fetus and vertex presentation was performed at 1 site. Women were randomized to receive patient-controlled IV analgesia titrated from 20 mcg up to… 
Effect and Safety of Remifentanil Patient-Controlled Analgesia Compared with Epidural Analgesia in Labor: An Updated Meta-Analysis of Randomized Controlled Trials
TLDR
RPCA could be an optional alternative for pain relief to EA without worsening maternal satisfaction with pain relief, delivery modes, or neonatal morbidity, however, rPCA was associated with higher pain intensity during labor and higher incidence of maternal oxygen desaturation.
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TLDR
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TLDR
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TLDR
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Patient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider.
TLDR
Evaluation of efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief finds it provides analgesia that is superior to nitrous oxide or other opioids such as meperidine, but is less effective when compared with epidural analgesia.
Patient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider.
TLDR
Evaluation of efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief finds it provides analgesia that is superior to nitrous oxide or other opioids such as meperidine, but is less effective when compared with epidural analgesia.
Patient‐controlled analgesia with remifentanil vs. alternative parenteral methods for pain management in labour: a Cochrane systematic review
TLDR
Evidence was found that women using patient‐controlled remifentanil were more satisfied with pain relief than women receiving parenteral opioids and were less satisfied with epidural analgesia, but there was no conclusion on adverse events.
Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on Obstetric Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials
TLDR
Compared with nonepidural analgesia, epidural morphine with LCLAs is not associated with a prolonged duration of the second stage of labor or an increased instrumental birth rate, and these conclusions require confirmation by large-sample and high-quality trials in the future.
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References

SHOWING 1-10 OF 29 REFERENCES
Labour analgesia: a randomised, controlled trial comparing intravenous remifentanil and epidural analgesia with ropivacaine and fentanyl
TLDR
Remifentanil IVPCA and epidural provided effective analgesia, with high maternal satisfaction scores and reassuring neonatal outcome, and the Neonatal outcome was reassuring.
A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour.
TLDR
In the 20 patients recruited to this study, pain relief in labour with epidural ropivacaine/sufentanil was more effective than with intravenous remifENTanil patient-controlled analgesia.
Patient-controlled analgesia for labour using remifentanil: a feasibility study.
TLDR
It is concluded that a patient-controlled analgesia system (bolus doses 0.25-0.5 microg x kg(-1), without a background infusion) may safely provide worthwhile, although incomplete, analgesia for labour.
Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens
TLDR
This pilot study suggests that remifentanil intravenous PCA is efficacious for labour analgesia as a bolus of 0.25 μg·kg-1·min-1, and the regimen used in Group A was associated with fewer side effects compared to the Group B dosing regimen.
Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour.
TLDR
Remifentanil by PCA gave better pain relief to mothers in labour than intramuscular meperidine, however, remifENTanil is a potent respiratory depressant and adequate continuous monitoring is necessary.
Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour.
TLDR
The efficacy of meperidine, fentanyl, and remifentanil PCA for labour analgesia varied from mild to moderate, and overall satisfaction scores were higher with remifetanil, but remifENTanil produced more sedation and itching.
A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children.
TLDR
Greater epidural use of tramadol may be preferred to morphine for postoperative analgesia under these circumstances under the circumstances of allergic rash, itching, sedation and respiratory depression.
A randomized comparison of levobupivacaine, bupivacaine and ropivacaine with fentanyl, for labor analgesia.
TLDR
All three regimens were effective during first stage of labor although pain scores were higher in those receiving levobupivacaine.
Remifentanil in obstetrics
  • D. Hill
  • Medicine
    Current opinion in anaesthesiology
  • 2008
TLDR
Remifentanil has a place in obstetric anaesthesia and analgesia but further studies are needed to confirm if background infusions are safe in addition to patient-controlled analgesia and to establish a dose range under general anaesthesia that prevents neonatal respiratory depression at birth.
Patient controlled analgesia for labour: a comparison of remifentanil with pethidine *
TLDR
The analgesic efficacy and safety of remifentanil and pethidine via patient controlled analgesia for women in established uncomplicated labour and visual analogue scores for pain during the study and for overall pain were similar.
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