A double-blind randomised comparison of intravenous patient-controlled remifentanil with intramuscular pethidine for labour analgesia.

Author(s): Ng TK, Cheng BC, Chan WS, Lam KK, Chan MT

Affiliation(s): Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong SAR. tonyktng@gmail.com

Publication date & source: 2011-09, Anaesthesia., 66(9):796-801. Epub 2011 Jun 24.

Publication type: Comparative Study; Randomized Controlled Trial

In a prospective, double-blind, randomised controlled trial, we compared the efficacy of patient-controlled analgesia using remifentanil (25-30 mug per bolus) with intramuscular pethidine (50-75 mg) for labour analgesia in 69 parturients. Parturients receiving patient-controlled analgesia reported less pain than those receiving intramuscular pethidine throughout the study period (p < 0.001), with maximal reduction in visual analogue pain score at 2 h after commencement of analgesia (mean (SD) 20 (17) in the patient-controlled analgesia group and 36 (22) in the intramuscular pethidine group. The median (95% CI) time to the first request for rescue analgesics was significantly longer with patient-controlled analgesia (8.0 (6.8-9.2) h) compared with intramuscular pethidine (4.9 (3.8-5.4) h, p < 0.001). Maternal satisfaction scores were also higher with remifentanil compared with intramuscular pethidine (p= 0.001). There was no report of sedation, aponea or oxygen desaturation in either group, and Apgar scores were similar between groups. We conclude that patient-controlled analgesia with remifentanil provides better labour analgesia and maternal satisfaction than intramuscular pethidine. At this dose, maternal and fetal side effects were uncommon. (c) 2011 The Authors. Anaesthesia (c) 2011 The Association of Anaesthetists of Great Britain and Ireland.