Introduction

The aim of the study was to compare the analgesic efficacy and side effects of remifentanil intravenous patient-controlled analgesia (IVPCA) with walking epidural analgesia (EDA) during labour.

Methods

A total of 39 parturient patients of mixed parity, with normal singleton pregnancies, were randomised to receive either remifentanil IVPCA (RA group) or EDA (EA group). The epidural solution contained ropivacaine 1 ?mg/?ml and fentanyl 2? µg/?ml, and the initial dose was 10 ?ml?/h. The starting bolus of remifentanil was 0.15?µg/?kg, with subsequent steps of 0.15? µg/?kg. Lock-out time was 2 ?minutes, the bolus infusion speed was 2? ml/?min (100? µg/?min) and there was no background infusion. The visual analogue scale was used for pain assessment. Maternal heart rate, blood pressure, oxygen saturation, respiratory rate, sedation, nausea/vomiting, itching, satisfaction and fetal/neonatal outcome were recorded.

Results

A total of 37 parturient patients were analysed. Both treatments provided good analgesia, but with higher pain scores in the RA group. Pain reduction at the end of first and during the second stage and maximum pain reduction were similar (RA/EA group): 27/26 (p?=?0.920), 31/29 (p=?0.909) and 61/59 (p?=?0.855), respectively. Maternal satisfaction was similar. Two parturients receiving remifentanil (6%) converted to epidural, one because of inadequate analgesia. Remifentanil produced more maternal sedation, desaturation (SaO₂?<?92%) and need for supplemental oxygen. Neonatal outcome was reassuring. Highest mean total dose of remifentanil was 0.70 ?µg?/kg (range 0.30–1.05).

Conclusion

The authors conclude that remifentanil IVPCA and epidural provided effective analgesia, with high maternal satisfaction scores and reassuring neonatal outcome. They point out that remifentanil produced more maternal sedation and oxygen desaturation, which makes close monitoring mandatory.