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Meperidine Compared With Nitrous Oxide for Intrapartum Pain Relief in Multiparous Patients: A Randomized Controlled Trial. Obstet Gynecol 2023; 141:4-10. [PMID: 36701604 DOI: 10.1097/aog.0000000000005011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the efficacy and adverse effects of intravenous meperidine and inhaled nitrous oxide for intrapartum analgesia in multiparous patients. METHODS This randomized controlled trial was conducted in the delivery ward of a university teaching medical center in Afula, Israel. Multiparous patients with term, singleton pregnancies who were in labor were randomized in a 1:1 ratio to 50 mg intravenous meperidine or inhaled nitrous oxide. The primary outcome was pain intensity 20-30 minutes after analgesic administration, measured on a visual analog scale (VAS) from 0 to 10 cm. Secondary outcomes included the need for additional analgesia, labor length, delivery mode, patient satisfaction, and maternal and neonatal adverse effects. To detect a 1-cm (±2.6) difference in VAS score between the groups, 214 total participants were needed to achieve 80% power with an alpha of 0.05. RESULTS From August 2016 through May 2019, 214 participants were enrolled. Fourteen were excluded after randomization. Of the 200 analyzed, 102 received nitrous oxide, and 98 received intravenous meperidine. Demographic and obstetric variables were comparable between the two groups. The VAS score 20-30 minutes after analgesic administration did not differ between the groups (7.7±2.3 cm and 7.6±2.7 cm in the nitrous oxide and meperidine groups, respectively, P=.89). There were no significant differences between the groups in the rate of additional analgesic use, labor length, delivery mode, Apgar scores, rate of breastfeeding, patient satisfaction, or maternal and neonatal adverse effects. CONCLUSION Pain intensity was comparable in multiparous patients 20-30 minutes after administration of meperidine and nitrous oxide. Adverse effects were also comparable. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02783508.
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Sharpe EE, Rollins MD. Beyond the epidural: Alternatives to neuraxial labor analgesia. Best Pract Res Clin Anaesthesiol 2022; 36:37-51. [PMID: 35659959 DOI: 10.1016/j.bpa.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
Labor creates an intense pain experienced by women across the world. Although neuraxial analgesia is the most effective treatment of labor pain, in many cases, it may not be undesired, not available, or have contraindications. In addition, satisfaction with labor analgesia is not only determined by the efficacy of analgesia but a woman's sense of agency and involvement in the childbirth experience are also key contributors. Providing safe choices for labor analgesia and support is central to creating a tailored, safe, and effective analgesic treatment plan with high maternal satisfaction. Healthcare provider knowledge of various nonneuraxial analgesic options, including efficacy, contraindications, safe clinical implementation, and side effects of various techniques is needed for optimal patient care and satisfaction. Future rigorous scientific studies addressing all of these labor analgesia options are needed to improve our understanding. This review summarizes the current published literature for commonly available non-neuraxial labor analgesic options.
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Affiliation(s)
- Emily E Sharpe
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Mark D Rollins
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Yin W, Jung F, Adams D, Konig G, Romeo RC, Lim G. Case Report of Remifentanil Labor Analgesia for a Pregnant Patient With Congenital Methemoglobinemia Type 1. A A Pract 2021; 15:e01373. [PMID: 33449539 DOI: 10.1213/xaa.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital methemoglobinemia is a rare disease characterized by cyanosis and a left shifting of the oxyhemoglobin dissociation curve. The disease necessitates avoidance of certain medications commonly used in obstetrics, making labor analgesia and anesthesia challenging. We present a case report of peripartum anesthetic management of a pregnant patient with congenital methemoglobinemia type 1 who received remifentanil labor analgesia and continuous methemoglobin monitoring. Continuous real-time monitoring of methemoglobin concentrations may prove to be a useful monitor in future care settings. A review of literature encompassing various perioperative and obstetric anesthesia and analgesia management considerations is presented.
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Affiliation(s)
- Wu Yin
- From the Department of Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital
| | - Francesca Jung
- From the Department of Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital
| | - Douglas Adams
- From the Department of Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital
| | - Gerhardt Konig
- From the Department of Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital
| | - Ryan C Romeo
- From the Department of Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital
| | - Grace Lim
- From the Department of Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital.,Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Charpentier S, Galinski M, Bounes V, Ricard-Hibon A, El-Khoury C, Elbaz M, Ageron FX, Manzo-Silberman S, Soulat L, Lapostolle F, Gérard A, Bregeaud D, Bongard V, Bonnefoy-Cudraz E. Nitrous oxide/oxygen plus acetaminophen versus morphine in ST elevation myocardial infarction: open-label, cluster-randomized, non-inferiority study. Scand J Trauma Resusc Emerg Med 2020; 28:36. [PMID: 32398160 PMCID: PMC7218609 DOI: 10.1186/s13049-020-00731-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background Studies have shown disparate results on the consequences of morphine use in ST-segment elevation myocardial infarction (STEMI). No study has evaluated alternative treatments that could be at least non-inferior to morphine without its potentially damaging consequences for myocardial function and platelet reactivity. The aim of this study was to evaluate whether nitrous oxide/oxygen plus intravenous acetaminophen (NOO-A) is non-inferior to morphine to control chest pain in STEMI patients. Methods This multicenter, open-label, cluster-randomized, controlled, non-inferiority study compared NOO-A with morphine in 684 prehospital patients with ongoing suspected STEMI of < 12 h duration and a pain rating score ≥ 4. The primary endpoint was the proportion of patients achieving pain relief (numeric rating score ≤ 3) after 30 min. Secondary safety endpoints included serious adverse events and death at 30 days. Results The median baseline pain score was 7.0 in both groups. The primary endpoint occurred in 51.7% of the NOO-A group and 73.6% of the morphine group (absolute risk difference − 21.7%; 95% confidence interval − 29.6 to − 13.8). At 30 days, the rate of serious adverse events was 16.0 and 18.8% in the NOO-A and morphine groups respectively (p = NS). The rate of death was 1.8% (NOO-A group) and 3.8% (morphine group) (p = NS). Conclusion Analgesia provided by NOO-A was inferior to morphine at 30 min in patients with acute STEMI in the prehospital setting. Rates of serious adverse events did not differ between groups. Trial registration ClinicalTrials.gov: NCT02198378.
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Affiliation(s)
- Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, INSERM UMR 1027, University Toulouse III Paul Sabatier, Toulouse, France. .,Emergency Department, Rangueil University Hospital, 1 Av. Jean Poulhès, 31059, Toulouse, France.
| | - Michel Galinski
- Emergency Department - SAMU 33, CHU de Bordeaux; INSERM U1219 - Injury Epidemiology Transport Occupation" team, University Bordeaux II, 33000, Bordeaux, France
| | - Vincent Bounes
- SAMU31, Toulouse University Hospital; University Toulouse III Paul Sabatier, Toulouse, France
| | - Agnès Ricard-Hibon
- Pôle Emergency Department, SAMU - Centre Hospitalier René Dubos Pontoise, 95300, Pontoise, France
| | - Carlos El-Khoury
- Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France.,Univ. Lyon, Claude Bernard Lyon 1 University, HESPER EA, 7425, Lyon, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | | | - Stéphane Manzo-Silberman
- Cardiology department, Lariboisire Hospital, APHP, Paris, France.,Paris VII University UMRS 942, Paris, France
| | - Louis Soulat
- SAMU 35 SMUR Urgences adultes, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France
| | - Frédéric Lapostolle
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942 Hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93009, Bobigny, France
| | - Alexandre Gérard
- Hospices Civils de Lyon SAMU 69 - Hôpital Édouard HERRIOT 5, place d'Arsonval, 69437, LYON Cedex 03, France
| | | | - Vanina Bongard
- Department of Epidemiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Department of Public Health, Université Toulouse 3; UMR 1027 INSERM - Université Toulouse 3, Toulouse, France
| | - Eric Bonnefoy-Cudraz
- Hôpital cardiologique Louis-Pradel, 69500, Lyon, France.,Université Lyon-1, 69100, Lyon, France
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6
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Ronel I, Weiniger CF. Non-regional analgesia for labour: remifentanil in obstetrics. BJA Educ 2019; 19:357-361. [PMID: 33456858 DOI: 10.1016/j.bjae.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- I Ronel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C F Weiniger
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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7
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Ronel I, Weiniger CF. A broadening choice for labor analgesia: remifentanil on the á la carte menu. Int J Obstet Anesth 2019; 39:1-6. [PMID: 31230989 DOI: 10.1016/j.ijoa.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- I Ronel
- Department of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - C F Weiniger
- Department of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Baysinger CL. Inhaled Nitrous Oxide Analgesia for Labor. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buhre W, Disma N, Hendrickx J, DeHert S, Hollmann MW, Huhn R, Jakobsson J, Nagele P, Peyton P, Vutskits L. European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice. Br J Anaesth 2019; 122:587-604. [PMID: 30916011 DOI: 10.1016/j.bja.2019.01.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/26/2018] [Accepted: 01/13/2019] [Indexed: 12/12/2022] Open
Abstract
Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings. This narrative review describes current knowledge regarding the clinical use of N2O based on a systematic and critical analysis of the available scientific literature. The pharmacological properties of N2O are reviewed in detail along with current evidence for the indications and contraindications of this drug in specific settings, both in perioperative care and in procedural sedation. Novel potential applications for N2O for the prevention or treatment of chronic pain and depression are also discussed. In view of the available evidence, we recommend that the supply of N2O in hospitals be maintained while encouraging its economic delivery using modern low flow delivery systems. Future research into its potential novel applications in prevention or treatment of chronic conditions should be pursued to better identify its role place in the developing era of precision medicine.
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Affiliation(s)
- Wolfgang Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, University of Maastricht, Maastricht, the Netherlands
| | - Nicola Disma
- Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Jan Hendrickx
- Department of Anesthesiology, Onze-Lieve-Vrouwziekenhuis Hospital Aalst, Aalst, Belgium
| | - Stefan DeHert
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Ghent, Belgium
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center (AUMC), AMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ragnar Huhn
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jan Jakobsson
- Department of Anesthesiology and Intensive Care, Institution for Clinical Science, Karolinska Institute, Danderyds University Hospital, Danderyd, Sweden
| | - Peter Nagele
- Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, IL, USA
| | - Philip Peyton
- Department of Anaesthesia, Austin Health, and Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Laszlo Vutskits
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals Geneva, Genève, Switzerland
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Abstract
BACKGROUND Parenteral opioids (intramuscular and intravenous drugs including patient-controlled analgesia) are used for pain relief in labour in many countries throughout the world. This review is an update of a review first published in 2010. OBJECTIVES To assess the effectiveness, safety and acceptability to women of different types, doses and modes of administration of parenteral opioid analgesia in labour. A second objective is to assess the effects of opioids in labour on the baby in terms of safety, condition at birth and early feeding. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (11 May 2017) and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient-controlled analgesia) for women in labour. Cluster-randomised trials were also eligible for inclusion, although none were identified. We did not include quasi-randomised trials. We looked at studies comparing an opioid with another opioid, placebo, no treatment, other non-pharmacological interventions (transcutaneous electrical nerve stimulation (TENS)) or inhaled analgesia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of each evidence synthesis using the GRADE approach. MAIN RESULTS We included 70 studies that compared an opioid with placebo or no treatment, another opioid administered intramuscularly or intravenously or compared with TENS applied to the back. Sixty-one studies involving more than 8000 women contributed data to the review and these studies reported on 34 different comparisons; for many comparisons and outcomes only one study contributed data. All of the studies were conducted in hospital settings, on healthy women with uncomplicated pregnancies at 37 to 42 weeks' gestation. We excluded studies focusing on women with pre-eclampsia or pre-existing conditions or with a compromised fetus. Overall, the evidence was graded as low- or very low-quality regarding the analgesic effect of opioids and satisfaction with analgesia; evidence was downgraded because of study design limitations, and many of the studies were underpowered to detect differences between groups and so effect estimates were imprecise. Due to the large number of different comparisons, it was not possible to present GRADE findings for every comparison.For the comparison of intramuscular pethidine (50 mg/100 mg) versus placebo, no clear differences were found in maternal satisfaction with analgesia measured during labour (number of women satisfied or very satisfied after 30 minutes: 50 women; 1 trial; risk ratio (RR) 7.00, 95% confidence interval (CI) 0.38 to 128.87, very low-quality evidence), or number of women requesting an epidural (50 women; 1 trial; RR 0.50, 95% CI 0.14 to 1.78; very low-quality evidence). Pain scores (reduction in visual analogue scale (VAS) score of at least 40 mm: 50 women; 1 trial; RR 25, 95% CI 1.56 to 400, low-quality evidence) and pain measured in labour (women reporting pain relief to be "good" or "fair" within one hour of administration: 116 women; 1 trial; RR 1.75, 95% CI 1.24 to 2.47, low-quality evidence) were both reduced in the pethidine group, and fewer women requested any additional analgesia (50 women; 1 trial; RR 0.71, 95% CI 0.54 to 0.94, low-quality evidence).There was limited information on adverse effects and harm to women and babies. There were few results that clearly showed that one opioid was more effective than another. Overall, findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We did not have sufficient evidence to assess which opioid drug provided the best pain relief with the least adverse effects. AUTHORS' CONCLUSIONS Though most evidence is of low- or very-low quality, for healthy women with an uncomplicated pregnancy who are giving birth at 37 to 42 weeks, parenteral opioids appear to provide some relief from pain in labour but are associated with drowsiness, nausea, and vomiting in the woman. Effects on the newborn are unclear. Maternal satisfaction with opioid analgesia was largely unreported. The review needs to be examined alongside related Cochrane reviews. More research is needed to determine which analgesic intervention is most effective, and provides greatest satisfaction to women with acceptable adverse effects for mothers and their newborn.
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Affiliation(s)
- Lesley A Smith
- Oxford Brookes UniversityDepartment of Psychology, Social Work and Public HealthJack Straws LaneMarstonOxfordUKOX3 0FL
| | - Ethel Burns
- Faculty of Health and Life Sciences, Oxford Brookes UniversityDepartment of Psychology, Social Work and Public HealthJack Straws LaneOxfordUKOX3 0FL
| | - Anna Cuthbert
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Sheyklo SG, Hajebrahimi S, Moosavi A, Pournaghi-Azar F, Azami-Aghdash S, Ghojazadeh M. Effect of Entonox for pain management in labor: A systematic review and meta-analysis of randomized controlled trials. Electron Physician 2018; 9:6002-6009. [PMID: 29560153 PMCID: PMC5843427 DOI: 10.19082/6002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 10/27/2017] [Indexed: 12/16/2022] Open
Abstract
Background and aim Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor. Methods This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used. Results Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was −1.01 (95% CI: −1.59 to −0.43, Q=148.5, df=8, p=0.02, I2=76) this difference was significant (p<0.05). The overall Apgar score standard difference in mean between-groups (Entonox vs. comparison) was 0.12 (95% CI: 0.01 to 0.23, Q=109.4, df=16, p=0.00, I2=85.3) this difference was significant (p<0.05). The results of mothers’ satisfaction rate show that mothers in Entonox group has a high level of satisfaction rate. Conclusion According to results of studies published in Iran, it seems that Entonox is an effective method for pain relief in vaginal delivery, as well as for improving infant Apgar score and mothers’ satisfaction rate. Pain relief through Entonox can be used as a strategy for cesarean section reduction plan in Iran.
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Affiliation(s)
- Sepideh Gareh Sheyklo
- Assistant Professor, Department of Obstetrics and Gynecology, Dezful University of Medical Sciences, Dezful, Iran
| | - Sakineh Hajebrahimi
- Professor, Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Moosavi
- Associate Professor, Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Fatemeh Pournaghi-Azar
- Assistant Professor, Dental and Periodontal Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Associate Professor, Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
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Melber AA, Sia ATH. “Do no harm” - Where to place remifentanil for labour analgesia? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.10.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jochberger S, Ortner C, Klein KU. [Pain therapy during labour]. Wien Med Wochenschr 2017; 167:368-373. [PMID: 28577077 DOI: 10.1007/s10354-017-0571-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
To date the gold standard of treating labour pain is regional analgesia by application of epidural analgesia. When offering epidural analgesia, the programmed intermittent epidural bolus (PIEB) is more effective in terms of pain reduction, less motor blocks and higher satisfaction of the parturient compared to continuous application via perfusor pump. An upcoming alternative to epidural analgesia is remifentanil, a short acting and potent opioid. Remifentanil, however, requires haemodynamic monitoring as cardiac and respiratory impairment has been described. Nitrous oxide has been used for decades in the Anglosphere but it is a greenhouse gas, and interactions with Vitamin B12 are possible. Using novel extraction systems, nitrous oxide has become more attractive for treatment of the initial phase of labour pain in Central Europe. In order to provide the parturient with the best possible and with a tailored pain concept an interdisciplinary approach with obstetricians, midwives and anaesthesiologists is required.
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Affiliation(s)
- Stefan Jochberger
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Clemens Ortner
- Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Klaus Ulrich Klein
- Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Weibel S, Jelting Y, Afshari A, Pace NL, Eberhart LHJ, Jokinen J, Artmann T, Kranke P. Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour. Cochrane Database Syst Rev 2017; 4:CD011989. [PMID: 28407220 PMCID: PMC6478102 DOI: 10.1002/14651858.cd011989.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Multiple analgesic strategies for pain relief during labour are available. Recently remifentanil, a short-acting opioid, has recently been used as an alternative analgesic due to its unique pharmacological properties. OBJECTIVES To systematically assess the effectiveness of remifentanil intravenous patient-controlled analgesia (PCA) for labour pain, along with any potential harms to the mother and the newborn. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 December 2015), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), handsearched congress abstracts (November 2015), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials comparing remifentanil (PCA) with another opioid (intravenous (IV)/intramuscular (IM)), or with another opioid (PCA), or with epidural analgesia, or with remifentanil (continuous IV), or with remifentanil (PCA, different regimen), or with inhalational analgesia, or with placebo/no treatment in all women in labour including high-risk groups with planned vaginal delivery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data, and appraised study quality.We contacted study authors for additional information other than incomplete outcome data. We performed random-effects meta-analysis.To reduce the risk of random error in meta-analysis we performed trial sequential analysis. We included total zero event trials and used a constant continuity correction of 0.01 (ccc 0.01) for meta-analysis. We applied the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to assess the quality of evidence. MAIN RESULTS Twenty RCTs with 3569 women were included. Of those, 10 trials (2983 participants) compared remifentanil (PCA) to an epidural, four trials (216 participants) to another opioid (IV/IM), three trials (215 participants) to another opioid (PCA), two trials (135 participants) to remifentanil (continuous IV), and one trial (20 participants) to remifentanil (PCA, different regimen). No trials were identified for the remaining comparisons.Methodological quality of studies was moderate to poor. We assessed risk of bias as high for blinding issues and incomplete outcome data in 65% and 45% of the included studies, respectively.There is evidence of effect that women in the remifentanil (PCA) group were more satisfied with pain relief than women in the other opioids (IV/IM) group (standardised mean difference (SMD) 2.11, 95% confidence interval (CI) 0.72 to 3.49, four trials, very low-quality evidence), and that women were less satisfied compared to women in the epidural group (SMD -0.22, 95% CI -0.40 to -0.04, seven trials, very low-quality evidence).There is evidence of effect that remifentanil (PCA) provided stronger pain relief at one hour than other opioids administered IV/IM (SMD -1.58, 95% CI -2.69 to -0.48, three trials, very low-quality evidence) or via PCA (SMD -0.51, 95% CI -1.01 to -0.00, three trials, very low-quality evidence). Pain intensity was higher in the remifentanil (PCA) group compared to the epidural group (SMD 0.57, 95% CI 0.31 to 0.84, six trials, low-quality evidence).Data were limited on safety aspects for both the women and the newborns. Only one study analysed maternal apnoea in a comparison of remifentanil (PCA) versus epidural and reported that half of the women in the remifentanil and none in the epidural group had an apnoea (very low-quality evidence). There is no evidence of effect that remifentanil (PCA) was associated with an increased risk for maternal respiratory depression when compared to epidural analgesia (RR 0.91, 95% CI 0.51 to 1.62, ccc 0.01, three trials, low-quality evidence) and no reliable conclusion might be reached compared to remifentanil (continuous IV) (all study arms included zero events, two trials, low-quality evidence). In one trial of remifentanil (PCA) versus another opioid (IM) three out of 18 women in the remifentanil and none out of 18 in the control group had a respiratory depression (very low-quality evidence).There is no evidence of effect that remifentanil (PCA) was associated with an increased risk for newborns with Apgar scores less than seven at five minutes compared to epidural analgesia (RR 1.26, 95% CI 0.62 to 2.57, ccc 0.01, five trials, low-quality evidence) and no reliable conclusion might be reached compared to another opioid (IV) and compared to remifentanil (PCA, different regimen) both with zero events in all study arms (one trial, very-low quality evidence). In one trial of remifentanil (PCA) versus another opioid (PCA) none out of nine newborns in the remifentanil and three out of eight in the opioid (PCA) group had Apgar scores less than seven (very-low quality evidence).There is evidence that remifentanil (PCA) was associated with a lower risk for the requirement of additional analgesia when compared to other opioids (IV/IM) (RR 0.57, 95% CI 0.40 to 0.81, three trials, moderate-quality evidence) and that it was associated with a higher risk compared to epidural analgesia (RR 9.27, 95% CI 3.73 to 23.03, ccc 0.01, six trials, moderate-quality evidence). There is no evidence of effect that remifentanil (PCA) reduced the requirement for additional analgesia compared to other opioids (PCA) (RR 0.76, 95% CI 0.45 to 1.28, three trials, low-quality evidence).There is evidence that there was no difference in the risk for caesarean delivery between remifentanil (PCA) and other opioids (IV/IM) (RR 0.63, 95% CI 0.30 to 1.32, ccc 0.01, four trials, low-quality evidence) and epidural analgesia (RR 1.0, 95% CI 0.82 to 1.22, ccc 0.01, nine trials, moderate-quality evidence), respectively. Pooled meta-analysis revealed an increased risk for caesarean section under remifentanil (PCA) compared to other opioids (PCA) (RR 2.78, 95% CI 0.99 to 7.82, two trials, very low-quality evidence). However, a wide range of clinically relevant and non-relevant treatment effects is compatible with this result. AUTHORS' CONCLUSIONS Based on the current systematic review, there is mostly low-quality evidence to inform practice and future research may significantly alter the current situation. The quality of evidence is mainly limited by poor quality of the studies, inconsistency, and imprecision. More research is needed on maternal and neonatal safety outcomes (maternal apnoea and respiratory depression, Apgar score) and on the optimal mode and regimen of remifentanil administration to provide highest efficacy with reasonable adverse effects for mothers and their newborns.
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Affiliation(s)
- Stephanie Weibel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Yvonne Jelting
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Arash Afshari
- Rigshospitalet, Copenhagen University HospitalJuliane Marie Centre ‐ Anaesthesia and Surgical Clinic Department 4013CopenhagenDenmark
| | - Nathan Leon Pace
- University of UtahDepartment of Anesthesiology3C444 SOM30 North 1900 EastSalt Lake CityUTUSA84132‐2304
| | - Leopold HJ Eberhart
- Philipps‐University MarburgDepartment of Anaesthesiology & Intensive Care MedicineBaldingerstrasse 1MarburgGermany35043
| | - Johanna Jokinen
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Thorsten Artmann
- Cnopf Children´s Hospital, Hospital HallerwieseDepartment of Anaesthesia and Intensive Care MedicineNuernbergGermany
| | - Peter Kranke
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
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Phillips SN, Fernando R, Girard T. Parenteral opioid analgesia: Does it still have a role? Best Pract Res Clin Anaesthesiol 2017. [DOI: 10.1016/j.bpa.2017.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Nitrous oxide, long used during labor in Europe, is gaining popularity in the United States. It offers many beneficial attributes, with few drawbacks. Cost, safety, and side effect profiles are favorable. Analgesic effectiveness is highly variable, yet maternal satisfaction is often high among the women who choose to use it. Despite being less effective in treating labor pain than neuraxial analgesic modalities, nitrous oxide serves the needs and preferences of a subset of laboring parturients. Nitrous oxide should, therefore, be considered for inclusion in the repertoire of modalities used to alleviate pain and facilitate effective coping during labor.
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Affiliation(s)
- Michael G Richardson
- Department of Anesthesiology, Vanderbilt University Medical Center, 4202 VUH, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Brandon M Lopez
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Curtis L Baysinger
- Department of Anesthesiology, Vanderbilt University Medical Center, 4202 VUH, 1211 Medical Center Drive, Nashville, TN 37232, USA
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Labor Pain. PAIN MEDICINE 2017. [DOI: 10.1007/978-3-319-43133-8_137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Najafi TF, Bahri N, Ebrahimipour H, Najar AV, Taleghani YM. Risk Assessment of Using Entonox for the Relief of Labor Pain: A Healthcare Failure Modes and Effects Analysis Approach. Electron Physician 2016; 8:2150-9. [PMID: 27123224 PMCID: PMC4844482 DOI: 10.19082/2150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/26/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In order to prevent medical errors, it is important to know why they occur and to identify their causes. Healthcare failure modes and effects analysis (HFMEA) is a type of qualitative descriptive that is used to evaluate the risk. The aim of this study was to assess the risks of using Entonox for labor pain by HFMEA. METHODS A mixed-methods design (qualitative action research and quantitative cross-sectional research) was used. The modes and effects of failures in the process of using Entonox were detected and analyzed during 2013-2014 at Hefdahe Shahrivar Hospital, Mashhad, Iran. Overall, 52 failure modes were identified, with 25 being recognized as high-risk modes. RESULTS The results revealed that 48.5% of these errors fall into the care process type, 22.05% belong to the communicative type, 19.1% fall into the administrative type, and 10.2% are of the knowledge and skills type. Strategies were presented in the forms of acceptance (3.2%), control (90.3%), and elimination (6.4%). CONCLUSION The following actions are suggested for improving the process of using Entonox: Close supervision by the midwife, precise recording of all the stages of the process in the woman's medical record, the necessity of the presence of the anesthesiologist at the woman's bedside during labor, confirming the indications for use of Entonox, and close monitoring to ensure the safety of the gas cylinder guards.
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Affiliation(s)
- Tahereh Fathi Najafi
- Ph.D. Student of Reproductive and Sexual Health, Department of Midwifery, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Narjes Bahri
- Ph.D. Student of Reproductive Health, Department of Midwifery, faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Hosein Ebrahimipour
- Ph.D. of Health services Management, Associate Professor, Health Sciences Research Center, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Vafaee Najar
- Ph.D. of Health Services Management, Associate Professor, Department of Health and Management, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasamin Molavi Taleghani
- Ph.D. Student of Health Services Administration, Health Management and Economics Research Center, Department of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
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Van de Velde M, Carvalho B. Remifentanil for labor analgesia: an evidence-based narrative review. Int J Obstet Anesth 2016; 25:66-74. [DOI: 10.1016/j.ijoa.2015.12.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/25/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022]
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Abdalla W, Ammar MA, Tharwat AI. Combination of dexmedetomidine and remifentanil for labor analgesia: A double-blinded, randomized, controlled study. Saudi J Anaesth 2015; 9:433-8. [PMID: 26543463 PMCID: PMC4610090 DOI: 10.4103/1658-354x.159470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Satisfactory analgesia is of great importance in the labor. The clinical efficacy and side effects of remifentanil in the management of labor pain had been evaluated. Dexmedetomidine (DMET) demonstrates an antinociceptive effect in visceral pain conditions. Aims of the study were to assess whether the combination of DMET with remifentanil would produce a synergistic effect that results in lower analgesic requirements. Furthermore, whether this combination would have less maternal and neonatal adverse effects. PATIENTS AND METHODS Sixty American Society of Anesthesiologists physical status I-II pregnant women had been enrolled into this study. All were full term (37-40 weeks' gestation), singleton fetus with cephalic presentation in the first stage of spontaneous labor. They were divided into two groups group (I) Patient-controlled IV remifentanil analgesia (bolus dose 0.25 μg/kg, lockout interval 2 min) increased by 0.25 μg/kg to a maximum bolus dose 1 μg/kg in addition to a loading dose of DMET 1 μg/kg over 20 min, followed by infusion at 0.5 μg/kg/h group (II) Patient-controlled IV remifentanil analgesia (PCA) (bolus dose 0.25 μg/kg, lockout interval 2 min) increased by 0.25 μg/kg to a maximum bolus dose 1 μg/kg in addition to a the same volume of normal saline as a loading dose, followed by a continuous saline infusion. Visual analog scale score, maternal, and fetal complications and patients' satisfaction were recorded. RESULTS Patients receiving a combination of PCA remifentanil and DMET had a lower pain score compared with remifentanil alone in the second stage of labor (P = 0.001). The Total consumption of remifentanil was reduced by 53.3% in group I. There was an increased incidence of maternal complications and a lower patient satisfaction score in group II. CONCLUSION DMET has an opioid sparing effect; a combination of DMET and remifentanil produces a synergistic effect that results in lower analgesic requirements and less maternal and neonatal adverse events.
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Affiliation(s)
- Waleed Abdalla
- Department of Anesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
| | - Mona Ahmed Ammar
- Department of Anesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
| | - Ayman Ibrahim Tharwat
- Department of Anesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
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Lin R, Tao Y, Yu Y, Xu Z, Su J, Liu Z. Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study. PLoS One 2014; 9:e112283. [PMID: 25386749 PMCID: PMC4227805 DOI: 10.1371/journal.pone.0112283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/13/2014] [Indexed: 11/29/2022] Open
Abstract
Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (P<0.0001), and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P<0.0001) and a higher sedation score (P<0.0001) within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8±0.4 vs. 3.7±0.6, P = 0.007) and pain relief score (2.9±0.3 vs. 2.8±0.4, P<0.0001) compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P<0.0001) was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation.
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Affiliation(s)
- Rong Lin
- Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yiyi Tao
- Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yibing Yu
- Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhendong Xu
- Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Su
- Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiqiang Liu
- Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- * E-mail:
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Remifentanil vs. epidural analgesia for the management of acute pain associated with labour. Systematic review and meta-analysis. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Remifentanilo vs. analgesia epidural para el manejo del dolor agudo relacionado con el trabajo de parto. Revisión sistemática y meta-análisis. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Birnbach DJ, Ranasinghe JS. Is remifentanil a safe and effective alternative to neuraxial labor analgesia? It all depends. Anesth Analg 2014; 118:491-3. [PMID: 24557091 DOI: 10.1213/ane.0000000000000117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- David J Birnbach
- From the *Department of Anesthesiology, Perioperative Medicine and Pain Management, and †Departments of Obstetrics and Gynecology and Public Health Sciences, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
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Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A Randomized Controlled Trial of the Efficacy and Respiratory Effects of Patient-Controlled Intravenous Remifentanil Analgesia and Patient-Controlled Epidural Analgesia in Laboring Women. Anesth Analg 2014; 118:589-97. [DOI: 10.1213/ane.0b013e3182a7cd1b] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Savage S, Ma D. The neurotoxicity of nitrous oxide: the facts and "putative" mechanisms. Brain Sci 2014; 4:73-90. [PMID: 24961701 PMCID: PMC4066238 DOI: 10.3390/brainsci4010073] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/08/2014] [Accepted: 01/16/2014] [Indexed: 02/03/2023] Open
Abstract
Nitrous oxide is a widely used analgesic agent, used also in combination with anaesthetics during surgery. Recent research has raised concerns about possible neurotoxicity of nitrous oxide, particularly in the developing brain. Nitrous oxide is an N-methyl-d-aspartate (NMDA)-antagonist drug, similar in nature to ketamine, another anaesthetic agent. It has been linked to post-operative cardiovascular problems in clinical studies. It is also widely known that exposure to nitrous oxide during surgery results in elevated homocysteine levels in many patients, but very little work has investigated the long term effect of these increased homocysteine levels. Now research in rodent models has found that homocysteine can be linked to neuronal death and possibly even cognitive deficits. This review aims to examine the current knowledge of mechanisms of action of nitrous oxide, and to describe some pathways by which it may have neurotoxic effects.
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Affiliation(s)
- Sinead Savage
- Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK.
| | - Daqing Ma
- Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK.
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Remifentanil vs. epidural analgesia for the management of acute pain associated with labour. Systematic review and meta-analysis☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442040-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tulp MJ, Paech MJ. Analgesia for childbirth: modern insights into an age-old challenge and the quest for an ideal approach. Pain Manag 2014; 4:69-78. [DOI: 10.2217/pmt.13.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
SUMMARY It is widely recognized that childbirth may be the most painful experience in a woman’s lifetime and that women have a right to relief. There are many options, but the efficacy of only a few is supported by robust evidence. Many influences determine which method of pain relief is chosen, including social and cultural factors, availability, cost and personal preference. Due to human diversity and the differing perspectives of consumers, obstetric care providers and health administrators, there is no such thing as ‘an ideal approach’. In resource-rich societies, major advances in parturient safety and outcome flow from technique development and better monitoring. Greater awareness of the negative impact of untreated pain and of the relevance of genetic, cultural and social factors motivates research into better predictive models, novel therapies and optimization of existing methods.
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Affiliation(s)
- Maartje J Tulp
- Department of Anaesthesia & Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, WA, Australia
| | - Michael J Paech
- Department of Anaesthesia & Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, WA, Australia
- School of Medicine & Pharmacology, The University of Western Australia, Perth, WA, Australia
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Varposhti MR, Ahmadi N, Masoodifar M, Shahshahan Z, Tabatabaie MH. Comparison of remifentanil: Entonox with Entonox alone in labor analgesia. Adv Biomed Res 2013; 2:87. [PMID: 24524033 PMCID: PMC3908727 DOI: 10.4103/2277-9175.122511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 02/03/2013] [Indexed: 01/30/2023] Open
Abstract
Background: We designed a study to evaluate the effectiveness of continuous low dose infusion of remifentanil adding to self-administration of entonox administered for pain relief during the active phase of first stage of labor. Materials and Methods: Thirty healthy term pregnant women recruited in our randomized double-blind, cross over study. They received the study medicines during two 30-min periods with a 15-min wash-out sequence after each period. Fifteen parturient used remifentanil as a single bolus dose followed by constant low dose infusion and self-administration of entonox (group R) during the first period and entonox and saline (group P) during the second period, while the remainder of the parturient used the drugs in a reverse order. Pain and Ramsay score, maternal and fetal hemodynamic, and ventilation were assessed during each intervention. Results: In this study, mean pain severity scores were 8 ± 0.9 before and 5.4 ± 1.7 after intervention in group P, and 7.8 ± 0.1, 3.5 ± 1.3 in group R, respectively. Mean pain severity difference was 2.6 ± 1.5 in group P, while 4.3 ± 1.5 in group R; so, use of entonox and remifentanil can decrease labor pain two times more in comparison with entonox/placebo (normal saline). However, hemodynamic and ventilation parameter in remifentanil/entonox period were same as in entonox/placebo period. No statistical differences were seen in mean Ramsay score between group R and P. There was no episode of maternal bradycardia, hypotension, or hypoxemia. Conclusion: Not only adding low dose infusion of remifentanil to self-administration of entonox was notable in labor pain reduction, it did n’t make more parturient and neonatal side-effects.
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Affiliation(s)
- Mojtaba Rahimi Varposhti
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naghmeh Ahmadi
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Masoodifar
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Shahshahan
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kranke P, Girard T, Lavand’homme P, Melber A, Jokinen J, Muellenbach RM, Wirbelauer J, Hönig A. Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a "poor man's epidural". BMC Pregnancy Childbirth 2013; 13:139. [PMID: 23815762 PMCID: PMC3700797 DOI: 10.1186/1471-2393-13-139] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units. Since the end of the 90 ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don't want, can't have or don't need epidural analgesia. DISCUSSION In view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions. However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a "poor man's epidural" and to safely administer remifentanil with an appropriate indication. SUMMARY Therefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia.
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Affiliation(s)
- Peter Kranke
- Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany
| | - Thierry Girard
- Department of Anaesthesia, University Hospital Basel, Spitalstrasse 21, Basel, CH 4031, Switzerland
| | - Patricia Lavand’homme
- Department of Anesthesiology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Andrea Melber
- Department of Anaesthesia, Salem-Spital, Schänzlistrasse 39, 3000, Bern 25, Switzerland
| | - Johanna Jokinen
- Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany
| | - Ralf M Muellenbach
- Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany
| | - Johannes Wirbelauer
- University Children’s Hospital, Josef-Schneider-Strasse 2, Würzburg 97080, Germany
| | - Arnd Hönig
- Department of Obstetrics and Gynecology, University Hospitals of Würzburg, Josef-Schneider-Strasse 4, Würzburg 97080, Germany
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Devabhakthuni S. Efficacy and safety of remifentanil as an alternative labor analgesic. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2013; 6:37-49. [PMID: 24665213 PMCID: PMC3941183 DOI: 10.4137/cmwh.s8015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The objective of this review was to evaluate the clinical efficacy and safety of remifentanil in the management of labor pain. Although neuraxial analgesia is the best option during labor, alternative analgesic options are needed for patients with contraindications. Using a systematic literature search, clinical outcomes of remifentanil for labor pain have been summarized. Also, comparisons of remifentanil to other options including meperidine, epidural analgesia, fentanyl, and nitrous oxide are provided. Based on the literature review, remifentanil is associated with high overall maternal satisfaction and favorable side-effect profile. However, due to the low reporting of adverse events, large, randomized controlled trials are needed to evaluate maternal and neonatal safety adequately and determine the optimal dosing needed to provide effective analgesia. While remifentanil is a feasible alternative for patients who cannot or do not want to receive epidural analgesia, administration should be monitored closely for potential adverse effects.
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Affiliation(s)
- Sandeep Devabhakthuni
- Assistant Professor of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
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Shen MK, Wu ZF, Zhu AB, He LL, Shen XF, Yang JJ, Feng SW. Remifentanil for labour analgesia: a double‐blinded, randomised controlled trial of maternal and neonatal effects of patient‐controlled analgesia versus continuous infusion. Anaesthesia 2013; 68:236-44. [PMID: 23294132 DOI: 10.1111/anae.12098] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Affiliation(s)
- M. K. Shen
- Department of Anaesthesiology Wuxi Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University Wuxi China
| | - Z. F. Wu
- Department of Anaesthesiology Jinlin Hospital School of Medicine Nanjing University Nanjing China
| | - A. B. Zhu
- Department of Anaesthesiology Wuxi Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University Wuxi China
| | - L. L. He
- State Key Laboratory of Reproductive Medicine Department of Anaesthesiology Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University Nanjing China
| | - X. F. Shen
- State Key Laboratory of Reproductive Medicine Department of Anaesthesiology Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University Nanjing China
| | - J. J. Yang
- Department of Anaesthesiology Jinlin Hospital School of Medicine Nanjing University Nanjing China
| | - S. W. Feng
- State Key Laboratory of Reproductive Medicine Department of Anaesthesiology Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University Nanjing China
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Efficacy and side effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study. Int J Obstet Anesth 2012; 22:19-25. [PMID: 23151415 DOI: 10.1016/j.ijoa.2012.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 07/03/2012] [Accepted: 09/16/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Remifentanil has a suitable pharmacological profile for labour analgesia. In this prospective, observational study, intravenous patient-controlled analgesia with remifentanil, using stepwise bolus doses without background infusion, was examined during the first and second stages of labour. Outcomes were pain reduction, maternal satisfaction, maternal and neonatal side effects and remifentanil metabolism in the neonate. METHODS Parturients with normal term singleton pregnancies were recruited. The initial remifentanil bolus dose was 0.15 μg/kg, increasing in steps of 0.15 μg/kg, with a 2-min lock-out. Pain scores using a 100 mm visual analogue scale, systolic and diastolic blood pressures, respiratory rate and maternal sedation were recorded every 15 min. Maternal oxygen saturation and heart rate were monitored continuously. Neonatal data included Apgar scores, clinical examination, naloxone use, resuscitation, umbilical cord blood gases and remifentanil concentrations. RESULTS Forty-one parturients were enrolled. Pain scores were significantly reduced in the first 3 h of patient-controlled analgesia use compared to baseline, and at the end of the first and second stages of labour (P<0.05). Maximal pain reduction was 60% (P<0.01). One patient had inadequate pain relief and converted to epidural analgesia. The mean highest dose of remifentanil was 0.7 μg/kg [range 0.3-1.05]. Ninety-three percent of patients were satisfied with their analgesia. The lowest oxygen saturation was 91% and the lowest respiratory rate was 9 breaths/min. Eleven parturients (27%) received supplemental oxygen due to oxygen saturations <92%. Maternal sedation was moderate, and neonatal data reassuring. CONCLUSIONS Remifentanil intravenous patient-controlled analgesia provides adequate pain relief and high maternal satisfaction during the first and second stages of labour. Maternal sedation and respiratory depression may occur, but no serious neonatal side effects were recorded. Careful monitoring is mandatory.
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Jost A, Ban B, Kamenik M. Modified patient‐controlled remifentanil bolus delivery regimen for labour pain*. Anaesthesia 2012; 68:245-52. [DOI: 10.1111/anae.12038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - B. Ban
- Anaesthesia Resident, Department of Anaesthesiology, Intensive Care and Pain Management, General Hospital Celje, Celje, Slovenia
| | - M. Kamenik
- Professor, Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia
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Klomp T, van Poppel M, Jones L, Lazet J, Di Nisio M, Lagro-Janssen ALM. Inhaled analgesia for pain management in labour. Cochrane Database Syst Rev 2012:CD009351. [PMID: 22972140 DOI: 10.1002/14651858.cd009351.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Many women would like to have a choice in pain relief during labour and also would like to avoid invasive methods of pain management in labour. Inhaled analgesia during labour involves the self-administered inhalation of sub-anaesthetic concentrations of agents while the mother remains awake and her protective laryngeal reflexes remain intact. Most of the agents are easy to administer, can be started in less than a minute and become effective within a minute. OBJECTIVES To examine the effects of all modalities of inhaled analgesia on the mother and the newborn for mothers who planned to have a vaginal delivery. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2012), ClinicalTrials.gov, and Current Controlled Trials (2 June 2012), handsearched conference proceedings from the American Society of Clinical Anesthesia (from 1990 to 2011), contacted content experts and trialists and searched reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials comparing inhaled analgesia with other inhaled analgesia or placebo or no treatment or other methods of non-pharmacological pain management in labour. DATA COLLECTION AND ANALYSIS Review authors independently assessed trials for eligibility, methodological quality and extracted all data. Data were double checked for accuracy. MAIN RESULTS Twenty-six studies, randomising 2959 women, were included in this review.Inhaled analgesia versus a different type of inhaled analgesia Pain relief was measured using a Visual Analogue Scale (VAS) from 0 to 100 mm where 100 corresponds to the most relief. Pain intensity was measured using a VAS from 0 to 100 mm, where 0 corresponds to no pain at all and 100 corresponds to the worst pain. The highest score for pain relief is the most positive in contrast to 'pain intensity' in which the higher score is more negative. Flurane derivatives were found to offer better pain relief than nitrous oxide in first stage of labour as measured by a lower pain intensity score (average mean difference (MD) 14.39, 95% confidence interval (CI) 4.41 to 24.37, three studies, 70 women), also a higher pain relief score for flurane derivatives compared with nitrous oxide (average MD -16.32, 95% CI -26.85 to -5.79, two studies, 70 women). Substantial heterogeneity was found in the analyses of pain intensity (P = 0.003) and in the analysis of pain relief (P = 0.002).These findings should be considered with caution because of the questionable design of the included cross-over trials. More nausea was found in the nitrous oxide group compared with the flurane derivatives group (risk ratio (RR) 6.60 95% CI 1.85 to 23.52, two studies, 98 women).Inhaled analgesia versus placebo or no treatment Placebo or no treatment was found to offer less pain relief compared to nitrous oxide (average RR 0.06, 95% CI 0.01 to 0.34, two studies, 310 women; MD -3.50, 95% CI -3.75 to -3.25, one study, 509 women). However, nitrous oxide resulted in more side effects for women such as nausea (RR 43.10, 95% CI 2.63 to 706.74, one study, 509 women), vomiting (RR 9.05, 95% CI 1.18 to 69.32, two studies, 619 women), dizziness (RR 113.98, 95% CI 7.09 to 1833.69, one study, 509 women) and drowsiness (RR 77.59, 95% CI 4.80 to 1254.96, one study, 509 women) when compared with placebo or no treatment.There were no significant differences found for any of the outcomes in the studies comparing one strength versus a different strength of inhaled analgesia, in studies comparing different delivery systems or in the study comparing inhaled analgesia with TENS.Due to lack of data, the following outcomes were not analysed within the review: sense of control; satisfaction with childbirth experience; effect on mother/baby interaction; breastfeeding; admission to special care baby unit; poor infant outcomes at long-term follow-up; or costs. AUTHORS' CONCLUSIONS Inhaled analgesia appears to be effective in reducing pain intensity and in giving pain relief in labour. However, substantial heterogeneity was detected for pain intensity. Furthermore, nitrous oxide appears to result in more side effects compared with flurane derivatives. Flurane derivatives result in more drowsiness when compared with nitrous oxide. When inhaled analgesia is compared with no treatment or placebo, nitrous oxide appears to result in even more side effects such as nausea, vomiting, dizziness and drowsiness. There is no evidence for differences for any of the outcomes comparing one strength verus a different strength of inhaled analgesia, comparing different delivery systems or comparing inhaled analgesia with TENS.
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Affiliation(s)
- Trudy Klomp
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center,Amsterdam, Netherlands.
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Heesen M, Veeser M. Analgesia in Obstetrics. Geburtshilfe Frauenheilkd 2012; 72:596-601. [PMID: 25264376 DOI: 10.1055/s-0031-1298444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/22/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
Abstract
Background: An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients. Methods: We performed a selective literature search in Medline via PubMed using the search-terms "Analgesia" and "Obstetrics". We also included the current guidelines of the German Society for Anesthesiology and Intensive Care Medicine. Results: PDA and CSE are safe techniques for the relief of labour pain if contraindications are excluded. The risk for instrumental delivery but not for caesarean section is increased under neuraxial analgesia. PDA and CSE should be performed in an early stage of labour using low doses of local anaesthetics if possible. It is not necessary to wait for a defined cervical dilatation before starting neuraxial analgesia. Anesthesiologists and obstetricians should inform patients as soon as possible before the situation of stress during labour. Systemic opioid analgesia is a possible alternative for neuraxial techniques. Because of possible side effects systemic remifentanil analgesia should only be performed under continuous monitoring. Several nonpharmacologic methods can also relieve labour pain, but results of studies about their effectiveness are inconsistent.
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Affiliation(s)
- M Heesen
- Anesthesiology, Sozialstiftung Bamberg, Bamberg
| | - M Veeser
- Anesthesiology, Sozialstiftung Bamberg, Bamberg
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Freeman LM, Bloemenkamp KWM, Franssen MTM, Papatsonis DNM, Hajenius PJ, van Huizen ME, Bremer HA, van den Akker ESA, Woiski MD, Porath MM, van Beek E, Schuitemaker N, van der Salm PCM, Fong BF, Radder C, Bax CJ, Sikkema M, van den Akker-van Marle ME, van Lith JMM, Lopriore E, Uildriks RJ, Struys MMRF, Mol BWJ, Dahan A, Middeldorp JM. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial. BMC Pregnancy Childbirth 2012; 12:63. [PMID: 22748068 PMCID: PMC3464937 DOI: 10.1186/1471-2393-12-63] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/02/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day. TRIAL REGISTRATION NUMBER Dutch Trial Register NTR2551, http://www.trialregister.nl.
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MESH Headings
- Adolescent
- Adult
- Analgesia, Epidural/adverse effects
- Analgesia, Epidural/economics
- Analgesia, Obstetrical/adverse effects
- Analgesia, Obstetrical/methods
- Analgesia, Patient-Controlled/adverse effects
- Analgesia, Patient-Controlled/economics
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/economics
- Analgesics, Opioid/therapeutic use
- Cost-Benefit Analysis
- Female
- Humans
- Infant, Newborn
- Labor, Obstetric
- Pain/drug therapy
- Pain Measurement
- Patient Satisfaction/economics
- Piperidines/adverse effects
- Piperidines/economics
- Piperidines/therapeutic use
- Pregnancy
- Remifentanil
- Research Design
- Young Adult
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Affiliation(s)
- Liv M Freeman
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kitty WM Bloemenkamp
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Maureen TM Franssen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - Petra J Hajenius
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Marloes E van Huizen
- Department of Obstetrics and Gynaecology, HagaZiekenhuis, Den Haag, the Netherlands
| | - Henk A Bremer
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Eline SA van den Akker
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Mallory D Woiski
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Martina M Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Erik van Beek
- Department of Obstetrics and Gynaecology, St. Antonius hospital, Nieuwegein, the Netherlands
| | - Nico Schuitemaker
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Paulien CM van der Salm
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - Bianca F Fong
- Department of Obstetrics and Gynaecology, Zaans Medical Centre, Zaandam, the Netherlands
| | - Celine Radder
- Department of Obstetrics and Gynaecology, St Lucas Andreas hospital, Amsterdam, the Netherlands
| | - Caroline J Bax
- Department of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam, the Netherlands
| | - Marko Sikkema
- Department of Obstetrics and Gynaecology, ZiekenhuisGroepTwente, Almelo, the Netherlands
| | | | - Jan MM van Lith
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Renske J Uildriks
- Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Michel MRF Struys
- Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Johanna M Middeldorp
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
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Bounes V. [Sedation and analgesia in emergency structure. Which sedation and/or analgesia during pregnancy?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:339. [PMID: 22445225 DOI: 10.1016/j.annfar.2012.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- V Bounes
- Samu 31, pôle de médecine d'urgences, université de Toulouse, hôpitaux universitaires, 31059 Toulouse cedex 9, France.
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Tramadol-metoclopramide or remifentanil for patient-controlled analgesia during second trimester abortion: a double-blinded, randomized controlled trial. J Clin Anesth 2012; 24:28-32. [DOI: 10.1016/j.jclinane.2011.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 05/12/2011] [Accepted: 05/20/2011] [Indexed: 11/29/2022]
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Leong WL, Sng BL, Sia ATH. A Comparison Between Remifentanil and Meperidine for Labor Analgesia. Anesth Analg 2011; 113:818-25. [DOI: 10.1213/ane.0b013e3182289fe9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schnabel A, Hahn N, Muellenbach R, Frambach T, Hoenig A, Roewer N, Kranke P. Geburtshilfliche Analgesie in deutschen Kliniken. Anaesthesist 2011; 60:995-1001. [DOI: 10.1007/s00101-011-1933-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/11/2011] [Accepted: 07/19/2011] [Indexed: 11/29/2022]
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Buehner U, Broadbent JR, Chesterfield B. Remifentanil Patient-Controlled Analgesia for Labour: A Complete Audit Cycle. Anaesth Intensive Care 2011; 39:666-70. [DOI: 10.1177/0310057x1103900421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Remifentanil patient-controlled analgesia (PCA) was introduced to a small maternity unit where an extensive epidural service was difficult to provide. This was a new service and the New Zealand College of Midwives had serious doubts about the efficacy and safety of remifentanil, so auditing its use was important. In a two-stage audit, clinical notes of 244 consecutive remifentanil users were studied between January 2008 and November 2009. We developed a questionnaire to assess the parturients’ satisfaction with remifentanil PCA and designed a proforma to evaluate it against four standards of best practice. During the two audit periods, timely commencement of PCA was achieved in 65% and 82% of cases, respectively. A 70% compliance rate with monitoring standards fell to 10% after the withdrawal of supervision by an acute pain team, but improved to 91% following implementation of regular midwifery training sessions and a redesigned partogram and prescription flowchart. Ninety-four percent of women rated remifentanil PCA as excellent, very good or good. Maternal side-effects were nausea, pruritus and drowsiness. A comparison of Apgar scores of consecutive neonates born by normal vaginal delivery to women receiving no analgesia, with those born to women using remifentanil PCA, demonstrated no difference. As a result of our audit, remifentanil PCA is now viewed by our midwives as an effective and safe method when accompanied by 1:1 care and appropriate monitoring. With our input other maternity units have introduced it, especially where epidural service provision is limited, and for patients in whom epidural analgesia is contraindicated.
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Affiliation(s)
- U. Buehner
- Department of Anaesthetics, Rotorua Hospital, Rotorua, New Zealand
| | - J. R. Broadbent
- Department of Anaesthetics, Rotorua Hospital, Rotorua, New Zealand
- Anaesthetic Department, Wellington Regional Hospital
| | - B. Chesterfield
- Department of Anaesthetics, Rotorua Hospital, Rotorua, New Zealand
- Anaesthetic Department, Wellington Regional Hospital
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Ng TKT, Cheng BCP, Chan WS, Lam KK, Chan MTV. A double-blind randomised comparison of intravenous patient-controlled remifentanil with intramuscular pethidine for labour analgesia*. Anaesthesia 2011; 66:796-801. [DOI: 10.1111/j.1365-2044.2011.06790.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anderson D. A Review of Systemic Opioids Commonly Used for Labor Pain Relief. J Midwifery Womens Health 2011; 56:222-39. [DOI: 10.1111/j.1542-2011.2011.00061.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Douma M, Middeldorp J, Verwey R, Dahan A, Stienstra R. A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour. Int J Obstet Anesth 2011; 20:118-23. [DOI: 10.1016/j.ijoa.2010.11.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/25/2010] [Accepted: 11/27/2010] [Indexed: 10/18/2022]
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