Comparison of the Effect of Incremental Bolus and Incremental Infusion Regimens of Remifentanil on Labour Pain

[摘要] Background:Mostpregnantwomenwhodeliverinobstetricsunitsrequirepharmacologicalornon-pharmacologicalpainrelieversthatcouldprovidepotentanalgesiceffectswithleastmaternalandneonataladverseeffects.Objectives:TheaimofthisinvestigationwastocomparetheefficacyandadversematernalandneonataleffectsofRemifentanilgivenbyboluspatient-controlledanalgesia(PCA)versuscontinuousintravenous(IV)infusionforlaboranalgesia.PatientsandMethods:Thisrandomized,single-blindclinicaltrialwasconductedon82nulliparousparturientwomenintheactivephaseoflabor,admittedtoAliEbn-eAbitalebHospital,Zahedan,IranfromJanuary2010toMarch2013.Theparticipantswererandomlyassignedintotwoequalgroupsof41.Intheinfusiongroup,patientsreceivedincrementalRemifentanilIVinfusionfrom0.025to0.1µg/kg/min.Inthebolusgroup,participantsreceivedincrementalPCAbolusRemifentanilfrom0.25to0.4µg/kgwithalock-outtimeoffourminutes.AverageVisualAnalogScale(AVAS)painscoresinstages1and2,laborduration,adverseeffects,neonataloutcomes,totalamountofadministeredRemifentanilandmaternalsatisfactionwereassessed.Results:Inbothmethods,thepainscoresweresignificantlyreducedafterRemifentaniladministrationinbothstagesoflabor(Plt;0.001).Therewerenostatisticallysignificantdifferencesinthepainintensityreductionbetweenthegroups(P=0.49,P=0.36,inthestagesIandIIoflabor,respectively).Therewerenostatisticallyremarkabledifferencesbetweenthetwogroupsforlaborduration(P=0.4),neonataloutcomes(P=0.9)andmaternalsatisfaction(P=0.8).ThetotalamountofadministeredRemifentanilwassignificantlylowerininfusiongroupcomparedtobolusgroup(P=0.001).Conclusions:Remifentanilinbothinfusionandbolusmethodscoulddecreaselaborpaininbothstageswithoutseriousmaternalorneonataladverseeffectsandwithoutincreasingthedurationoflabor.TheaveragedoseofRemifentanilneededtoreducepainwassignificantlylowerintheinfusionmethodcomparedtothebolusmethod.

[学科分类] 基础医学

[关键词] Analgesia;Remifentanil;Pain