Remifentanil patient-controlled analgesia for labour : optimizing drug delivery regimens

Mrinalini Balki; Shilpa Kasodekar; Sudhir Dhumne; Paul Bernstein; Jose C. A Carvalho

doi:10.1007/BF03022956

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Remifentanil patient-controlled analgesia for labour : optimizing drug delivery regimens

Journal article

Peer reviewed

Remifentanil patient-controlled analgesia for labour : optimizing drug delivery regimens

Mrinalini Balki, Shilpa Kasodekar, Sudhir Dhumne, Paul Bernstein and Jose C. A Carvalho

Canadian journal of anesthesia, Vol.54(8), pp.626-633

08/01/2007

DOI: 10.1007/BF03022956

PMID: 17666715

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Abstract

Purpose A pilot study was undertaken to compare the efficacy of two regimens of intravenous patient-controlled analgesia (PCA) with remifentanil for labour analgesia. Methods Twenty term parturients requesting labour analgesia were randomized to receive one of two regimens of intravenous remifentanil. The initial settings in both groups consisted of an infusion of 0.025 μg·kg-1·min-1, a PCA bolus of 0.25 μg·kg-1 and a lockout interval of two minutes. In Group A, the infusion was increased in a stepwise manner from 0.025 to 0.05, 0.075 and 0.1 μg·kg-1·min-1 as required; the bolus was kept constant at 0.25 μg·kg-1. In Group B, the bolus was increased from 0.25 to 0.5, 0.75 and 1 μg·kg-1 as necessary; the infusion was kept constant at 0.025 μg·kg-1·min-1. Maternal pain, satisfaction and sedation scores, remifentanil requirement, and side effects were recorded. Results Mean pain and patient satisfaction scores, and cumulative doses of remifentanil were similar in the two groups. The overall incidence of side effects was greater in Group B (P = 0.0007), with drowsiness observed in 100% of patients, as compared to 30% in Group A (P = 0.003). The minimum oxygen saturation levels were 94.3% ± 2.6% and 92.2% ± 3.8% in Groups A and B respectively (P = 0.19). Conclusions Although pain and satisfaction scores were similar in both groups, the regimen used in Group A was associated with fewer side effects compared to the Group B dosing regimen. This pilot study suggests that remifentanil intravenous PCA is efficacious for labour analgesia as a bolus of 0.25 μg·kg-1, with a lockout interval of two minutes and continuous infusion of 0.025-0.1 μg·kg-1·min-1. The potential for respiratory depression mandates close respiratory monitoring. Large-scale trials to evaluate safety issues are warranted.

Abdominal surgery. Urology. Gynecology. Obstetrics

Anesthesia

Anesthesia depending on type of surgery

Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy

Biological and medical sciences

Medical sciences

Details

Title: Subtitle: Remifentanil patient-controlled analgesia for labour : optimizing drug delivery regimens
Creators: Mrinalini Balki - University of Toronto
Shilpa Kasodekar - University of Toronto
Sudhir Dhumne - University of Toronto
Paul Bernstein - Mount Sinai Hospital
Jose C. A Carvalho - University of Toronto
Resource Type: Journal article
Publication Details: Canadian journal of anesthesia, Vol.54(8), pp.626-633
DOI: 10.1007/BF03022956
PMID: 17666715
NLM abbreviation: Can J Anaesth
ISSN: 0832-610X
eISSN: 1496-8975
Publisher: Canadian Anesthesiologists' Society
Number of pages: 8
Language: English
Date published: 08/01/2007
Academic Unit: Anesthesia
Record Identifier: 9984948145202771

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