Differences in maternal temperature during labour with remifentanil patient-controlled analgesia or epidural analgesia: a randomised controlled trial

作者：Douma M R^*; Stienstra R; Middeldorp J M; Arbous M S; Dahan A

来源：International Journal of Obstetric Anesthesia, 2015, 24(4): 313-322.

DOI：10.1016/j.ijoa.2015.06.003

• Analgesia epidural
• Analgesia
• Obstetrical
• Hypoxia
• Fever
• Remifentanil

Background: Epidural analgesia and remifentanil patient-controlled analgesia are two popular techniques for the treatment of labour pain, each with its own efficacy and toxicity.
Methods: Parturients 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 degrees C); secondary outcomes included the incidence of low oxygen saturation, pain scores, nausea and vomiting, sedation scores, pruritus and neonatal outcome.
Results: Data from 140 parturients were analysed: 49 received remifentanil analgesia, 49 epidural analgesia and 42 no analgesia (controls). Fever (temperature >= 38 degrees 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 ntensity 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.
Conclusions: During 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.

• 出版日期2015-11