Differences in maternal temperature during labour with remifentanil patient-controlled analgesia or epidural analgesia: a randomised controlled trial |
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| Affiliation: | 1. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands;2. Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands;3. Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands;4. Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands;1. Intensive Care Unit, Mount Sinai Hospital, Toronto, Canada;2. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada;3. Intensive Care Unit, Gestión Salud Clinic, Cartagena, Colombia;4. Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Gestión Salud Clinic, Cartagena, Colombia;5. Intensive Care Unit, Monash Medical Centre, Clayton, Victoria, Australia;6. The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Australia;7. Sanatorio Anchorena, Ciudad de Buenos Aires, Argentina;8. Universidad del Sinu, Cartagena, Colombia;9. Pulmonary and Critical Care Medicine, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA;10. The Miriam Hospital, Providence, RI, USA;1. Department of Ophthalmology, Castila La Mancha University, Albacete, Spain;2. IOBA, University of Valladolid, Valladolid, Spain;3. Pio del Rio Hortega University Hospital, Valladolid, Spain |
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| Abstract: | BackgroundEpidural analgesia and remifentanil patient-controlled analgesia are two popular techniques for the treatment of labour pain, each with its own efficacy and toxicity.MethodsParturients requesting analgesia were randomly assigned to either patient-controlled intravenous remifentanil or epidural analgesia. Control patients consisted of parturients not requesting pain medication. The primary objective was to compare the incidence of maternal fever (temperature ⩾38°C); secondary outcomes included the incidence of low oxygen saturation, pain scores, nausea and vomiting, sedation scores, pruritus and neonatal outcome.ResultsData from 140 parturients were analysed: 49 received remifentanil analgesia, 49 epidural analgesia and 42 no analgesia (controls). Fever (temperature ⩾38°C) developed in 10% of remifentanil patients compared to 37% of epidural patients and 7% of control patients (P <0.001). One or more hypoxaemic events (oxygen saturation <90% for at least 1 min) occurred in 48% of patients on remifentanil versus 15% of patients on epidural analgesia and 20% of control patients (P=0.003). Although pain intensity scores differed significantly between the two groups in favour of the epidural, mean satisfaction scores were similar in both analgesia groups (remifentanil 8.1 ± 1.2 vs. epidural 8.4 ± 1.2). Remifentanil analgesia was associated with a higher incidence of nausea and deeper levels of sedation. The differences in haemodynamic parameters between groups were small and clinically insignificant.ConclusionsDuring treatment of labour pain, epidural analgesia is associated with a higher incidence of maternal fever, while remifentanil analgesia results in more frequent and deeper hypoxaemic events. |
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| Keywords: | Analgesia epidural Analgesia Obstetrical Hypoxia Fever Remifentanil |
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