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Oulun yliopiston väitöskirjat

INTRAVENOUS PATIENT CONTROLLED ANALGESIA WITH REMIFENTANIL IN EARLY LABOUR, ACTA UNIVERSITATIS OULUENSIS D Medica 1044

ISBN-13:	978-951-42-6116-9
Kieli:	englanti
Kustantaja:	Oulun yliopisto
Oppiaine:	Lääketiede,farmasia
Painosvuosi:	2010
Sidosasu:	pehmeäkantinen
Sijainti:	Print Tietotalo
Sivumäärä:	168
Tekijät:	VOLMANEN PETRI

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In four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanilanalgesia during the 1st stage of labour. The median effective dose per bolus was ascertained to be0.4 ìg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0–10).Compared with nitrous oxide, 15 parturients included in a cross-over study reported a largerreduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p= 0.001) and better pain reliefscores (2.5 vs. 0.5 on a ranked five point scale 0–4, p < 0.001). In a parallel study including 45parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 ìg/ml) wasassociated with lower pain scores (5.2 vs. 7.3 with remifentanil, p= 0.004) but variables relatedto satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue withthe given medication and termination of the study due to inadequate pain relief) were similar. Acomparison of two methods for timing the remifentanil bolus during the uterine contraction cyclesuggested that delaying the bolus does not improve analgesia. A period effect was noted in thecross-over trial with higher pain scores and increased drug consumption during the second studyperiod suggesting acute hyperalgesia. Side effects of remifentanil analgesia included respiratory depression warranting oxygensupplementation in 33% of parturients. Sedation was experienced by the parturients usingremifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. Thenumber of parturients with nausea did not increase during remifentanil analgesia. Other maternalside effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracingabnormalities were noted. The incidence of abnormal tracings and decreased UapH were notdifferent, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5minute indicated no neonatal depression.

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