Study on low-dose remifentanil combined with Lamaza delivery for labor analgesia

Objective To explore the feasibility of intravenous infusion low-dose remifentanil combined with Lamaza delivery method and evaluate its impact on the maternal and neonatal outcome.Methods 240 cases of primipara were included with characteristics of full-pregnant,single birth,and vaginal delivery in our hospital from April 2012 to April 2013.They were randomly divided into four groups:without labor analgesia(group A),Lamaza delivery group(group B),low-dose remifentanil controlled intravenous infusion(the infusing rate:0.02μg·kg-1·min-1)combined Lamaza delivery group(group C),high-dose remifentanil controlled intravenous infusion(the infusing rate:0.04μg·kg-1·min-1)combined Lamaza delivery group(group D).In the process of delivery,visual analogue pain score(VAS)was assessed.The rate of oxytocin,the average time of maternal first stage of labor,the average time of second stage of labor,cesarean section rate,postpartum bleeding,and the total dose of remifentanil were also recorded.The side effect of labor analgesia,neonatal umbilical arterial blood gas and Apgar score were analyzed.Results Compared with group A,group C and group D showed more analgesia satisfactory in VAS(P0.01).The time of the active phase in the first stage in group C and group B was significantly shorter(P0.05).The maternal cesarean section rate of group C and group D was lower(P0.05).The total of remifentanil in group C was 154±58μg and less than in group D.The amount of postpartum hemorrhage in group C and group B were significantly lower.Group D had lower scores in Apgar score at 1minute and 5 minute,but Apgar scores at 10 minute in four groups were all more than 8 points.There was no difference in cord blood in pH,PaO2,PaCO2 and BE in the four groups(P0.05).Conclusion Low-dose remifentanil controlled intravenous infusion combined with Lamaza delivery can produce effective analgesic effect,and reduce the total dose of remifentanil.During the first active period of labor time,the occurrence of postpartum hemorrhage and cesarean section in parturients were deceased.However,there is little effect in Apgar score and umbilical arterial blood gas analysis in neonates.