Comparative study of labour analgesia with Intravenous remifentanil and epidural ropivacainewith fentanyl

Objective To assess the effect of remifentanil in patient-controlled intravenous analgesia (PCIA) and its impact on each stage of labor. Methods Totally 70 healthy parturient at 38—42 weeks with singleton at head position were randomized to receive either patient controlled intravenous analgesia with remifentanil (PCIA group) or patient controlled epidural analgesia with robupivacaine plus fentanyl (PCEA group),35 cases in each group. PCIA group’s background dose was 0.05 μg·kg-1·min-1 with 0. 5 μg/kg bolus and3 mins lock-out time. PCEA group was given2 mg/mL robupivacaine combined with2 μg/mL fentanyl and its initialdose was 3 mLwith 5 mL as bolus and 10 mins lock-out time.Two groups stopped analgesia until cervix completely opened. Before analgesia, 5 min, 10 min,20 min,30 min after analgesia and cervix completely open, Visual analogue score (VAS, 0 means painless and 10 means intolerable pain) and Ramsay score (RSS)were used separately to evaluate the extent of patients’ uterine contraction pain and sedation. Labor time, 1 min and 10 min Neonatal Apgar score, the intervention of obstetrics and side effect of drug were recorded for each group. Results Uterine contraction pain was quickly relieved when given analgesia in both groups. VAS in PCEA group was lower than PCIA group from 10 min after analgesia to cervix completely open (all P0.01).The labor time for first and second stage in PCIA group was shorter than PCEA group (both P0.01). Therewas nodifference between two groups in the rate of instrumental delivery, cesarean section rate or oxytocin usage (all P0. 05). Each group had one neonatal 1 min Apgar scored 7 points case and one 1 min Apgar scored 8with natural birth. The remaining neonatal 1 in Apgar score and all newborns 10 min Apgar scores were 10 points. There were no over sedation or hypoxemia in both groups. Conclusion Remifentanil with the mode of PCIA can ease labor pain effectively and safely. It is an effective complement for PCEA in labor analgesia. (Shanghai Med J,2013,36:320-322)