Remifentanil vs. epidural analgesia for the management of acute pain associated with labour. Systematic review and meta-analysis

  • Víctor Hugo González Cárdenas a. Deorum Opus Research Group at Hospital Infantil Universitario de San José, Bogotá, Colombia. b. Anaesthesia Department, Hospital Infantil Universitario de San José, Bogotá, Colombia. C. Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia. d. Universidad de la Sabana, Chía, Colombia
  • Fredy Danilo Munar González a. Anaesthesia Department, Hospital Infantil Universitario de San José, Bogotá, Colombia. b. Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.
  • Wilson Javier Gómez Barajas a. Anaesthesia Department, Hospital Infantil Universitario de San José, Bogotá, Colombia. b. Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia. c. Universidad de la Sabana, Chía, Colombia
  • Angélica María Cardona Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
  • Byron Rafael Rosero Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
  • Álvaro José Manrique Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
Keywords: Labor, Obstetric anesthesia, Conduction, Meta-analysis, Acute pain, Analgesics, Opioid

Abstract

Introduction: Remifentanil has an attractive pharmacological profile for use in obstetric analgesia as a technique for mass application, with similar benefits and satisfaction as epidural analgesia.

Objective: To assess the efficacy, equivalence and safety of remifentanil vs. epidural analgesia in obstetrics.

Methods: Systematic review and meta-analysis of clinical trials using the Cochrane methodology.

Results: No equivalence was found in relation to epidural analgesia; however, efficacy was found in the remifentanil group at different time points during the evaluation. The incidence of adverse effects was similar in the two groups, except for nausea.

Conclusions: Remifentanil is not equivalent to epidural analgesia but could certainly decrease the intensity of pain.

References

1. Robinson A, Lyons G, Wilson R. Levobupivacaine for epidural analgesia in labor: The sparing effect of epidural fentanyl. Anesth Analg. 2001;92:410-4.
2. Halpern S, Muir H, Breen T. A multicenter randomised controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor. Anesth Analg. 2004;99:1532-8.
3. Moore T, Key T, Reisner L, et al. Evaluation of the use of continuous lumbar epidural anesthesia for hypertensive pregnant women in labor. Am J Obstet Gynecol. 1985;152:404-12.
4. Head B, Jhon O, Robert D, et al. A randomized trial of intrapartum analgesia in women with severe preeclampsia. Obstet Gynecol. 2002;99:452-7.
5. Lao T, Halpern S, MacDonald D, Huh C. Spinal subdural haematoma in a parturient after attempted epidural anaesthesia. Can J Anaesth. 1993;40:340-5.
6. Yuen T, Kua J, Tan I. Spinal haematoma following epidural anaesthesia in a patient with eclampsia. Anaesthesia. 1999;54:350-4.
7. Mordani K, Macarthur A. Anesthesia considerations of preeclamptic patients. Preeclampsia, current perspectives on managements. 2004:196-99. Epub Philip N. Baker, and John C.P. Kingdom, Parthenon Publishing.
8. Morley-Foster P, Weberpals J. Neonatal effects of patient-controlled analgesia using fentanyl in labor. Int J Obstet Anesth. 1998;7:103-7.
9. Rayburn W, Smith C, Parriot J, Woods R. Randomized comparison of meperidine and fentanyl during labor. Obstet Gynecol. 1989;74:604-6.
10. González VH. Depresión respiratoria neonatal y fentanilo intratecal. Rev Colomb Anestesiol. 2012;40:100-5.
11. Leppä M, Korvenoja A, Carlson S. Acute opioid effects on human brain as revealed by functional magnetic resonance imaging. Neuroimage. 2006;31:661-9.
12. Kapila AGP, Jacobs JR. Measured context sensitive half-times of remifentanil and alfentanil. Anesthesiology. 1995;83:968-75.
13. Blair J, Dobson G, Hill D, McCracken G, Fee G. Patient controlled analgesia for labour: A comparison of remifentanil with pethidine. Anaesthesia. 2005;60:22-7.
14. Volmanen P, Sarvela J, Akural E, Raudaskoski T, Korttila K, Alahuhta S. Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: A randomised, controlled, double-blinded study. Acta Anaesthesiol Scand. 2008;52:249-55.
15. Higgins JPT. Cochrane handbook for systematic reviews of interventions. John Wiley and Sons. 2008.
16. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol. 2009;62:e1-34.
17. Kung J, Cajulis CF, Avezova OO, Kossan R, Chew GL, et al. From systematic reviews to clinical recommendations for evidence-based health care: Validation of revised assessment of multiple systematic reviews (R-AMSTAR) for grading of clinical relevance. Open Dent J. 2010;4:84-91.
18. Cerda J, Villarroel L. Evaluación de la concordancia inter-observador en investigación pediátrica: Coeficiente de Kappa. Rev Chil Pediatr. 2008;79:54-8.
19. World Health Organization. International Clinical Trials Registry Platform [consultado 29 Feb 2012]. Disponible en: http://appswhoint/trialsearch/.
20. Sołek-Pastuszka J, Kepinski S, Makowski A, Celewicz Z, Zukowski M, Safranow K, et al. Patient-controlled continuous epidural analgesia vs intravenous remifentanil infusion for labour anaesthesia. Anaesthesiology Intensive Therapy. 2009;XLI:71-5.
21. El-Kerdawy H, Farouk A. Labor analgesia in preeclampsia: Remifentanil patient controlled intravenous analgesia versus epidural analgesia. MEJ Anesth. 2010;20:539-46.
22. Douma MR, Middeldorp JM, Verwey RA, Dahan A. A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour. Int J Obstet Anesth. 2011;20:118-23.
23. Ng TK, Cheng BC, Chan WS, Lam KK, Chan MT. A double-blind randomised comparison of intravenous patient-controlled remifentanil with intramuscular pethidine for labour analgesia. Anaesthesia. 2011;66:796-801.
24. Natalini G, di Maio A, Rosano A, Ferretti P, Bertelli M, Bernardini A. Remifentanil improves breathing pattern and reduces inspiratory workload in tachypneic patients. Respir Care. 2011;56:827-33.
25. Volmanen PV, Akural EI, Raudaskoski T, Ranta P, Tekay A, Ohtonen P, et al. Timing of intravenous patient-controlled remifentanil bolus during early labour. Acta Anaesthesiol Scand. 2011;55:486-94.
26. Douma MR, Verwey RA, Kam-Endtz CE, van der Linden PD, Stienstra R. Obstetric analgesia: A comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth. 2009;104:209-15.
27. Evron S, Ezri T, Protianov M, Muzikant G, Sadan O, Herman A, et al. The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor. J Anesth. 2008;22:105-11.
28. Gospic K, Gunnarsson T, Fransson P, Ingvar M, Lindefors N, Petrovic P. Emotional perception modulated by an opioid and a cholecystokinin agonist. Psychopharmacology. 2008;197:295-307.
29. Balcioglu O, Akin S, Demir S, Aribogan A. Patient-controlled intravenous analgesia with remifentanil in nulliparous subjects in labor. Expert Opin Pharmacother. 2007;8: 3089-96.
30. Balki M, Kasodekar S, Dhumne S, Bernstein P, Carvalho JC. Remifentanil patient-controlled analgesia for labour: Optimizing drug delivery regimens. Can J Anaesth. 2007;54:626-33.
31. Volikas I, Butwick A, Wilkinson C, Pleming A, Nicholson G. Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour. Br J Anaesth. 2005;95:504-9.
32. Mesolella M, Lamarca S, Galli V, Ricciardiello F, Cavaliere M, Iengo M. Use of remifentanil for sedo-analgesia in stapedotomy: Personal experience. Acta Otorhinolaryngol Ital. 2004;24:315-20.
33. Volmanen P, Akural E, Raudaskoski T, Ohtonen P, Alahuhta S. Comparison of remifentanil and nitrous oxide in labour analgesia. Acta Anaesthesiol Scand. 2005;49:453-8.
34. Evron S, Glezerman M, Sadan O, Boaz M, Ezri T. Remifentanil: A novel systemic analgesic for labor pain. Anesth Analg. 2005;100:233-8.
35. Pleym H, Stenseth R, Wiseth R, Karevold A, Dale O. Supplemental remifentanil during coronary artery bypass grafting is followed by a transient postoperative cardiac depression. Acta Anaesthesiol Scand. 2004;48: 1155-62.
36. Volikas I, Male D. A comparison of pethidine and remifentanil patient-controlled analgesia in labour. Int J Obstet Anesth. 2001;10:86-90.
37. Thurlow JA, Laxton CH, Dick A, Waterhouse P, Sherman L, Goodman NW, et al. Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour. Br J Anaesth. 2002;88:374-8.
38. Volmanen P, Akural EI, Raudaskoski T, Alahuhta S. Remifentanil in obstetric analgesia: A dose-finding study. Anesth Analg. 2002;94:913-7.
39. Blair JM, Hill DA, Fee JP. Patient-controlled analgesia for labour using remifentanil: A feasibility study. Br J Anaesth. 2001;87:415-20.
40. Pittarello D, Bonato R, Armellin G, Sorbara C. Alterations in left ventricular-arterial coupling and mechanical efficiency produced by remifentanil during cardiac anesthesia. Minerva Anestesiol. 2001;67:133-47.
41. Roelants F, de Franceschi E, Veyckemans F, Lavand'homme P. Patient-controlled intravenous analgesia using remifentanil in the parturient. Can J Anaesth. 2001;48:175-8.
42. Olufolabi AJ, Booth JV, Wakeling HG, Glass PS, Penning DH, Reynolds JD. A preliminary investigation of remifentanil as a labor analgesic. Anesth Analg. 2000;91:606-8.
43. Soares ECS, Lucena MR, Ribeiro RC, Rocha L, Vilas Boas W. Remifentanil en analgesia para el trabajo de parto. Rev Bras Anestesiol. 2010;60:334-46.
44. Aristizábal JP, Londoño JD. Remifentanilo como alternativa para analgesia obstétrica. Rev Colomb Anestesiol. 2006;34:274-7.
45. Costa J, Mendes DMC, Lobo J, Furuguem ABR, Santos GG. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso. Rev Bras Anestesiol. 2005;55:217-23.
46. Vale N, Delfino J, Vale LF. O conhecimento de diferenças raciais pode evitar reações idiossincrásicas na anestesia? Rev Bras Anestesiol. 2003;53:258-77.
47. López-Millán JM, Alcañiz JB, de las Mulas M. Analgesia del trabajo de parto con remifentanilo por vía intravenosa mediante un sistema de Analgesia Controlada por la Paciente (PCIA). Rev Soc Esp del Dolor. 2007;14:416-21.
48. Ross AK, Davis PJ, Dear Gd GL, Ginsberg B, McGowan FX, Stiller RD, et al. Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures. Anesth Analg. 2001;93: 1393-401.
49. Kan RE, Hughes SC, Rosen MA, Kessin C, Preston PG, Lobo EP. Intravenous remifentanil: Placental transfer, maternal and neonatal effects. Anesthesiology. 1998;88:1467-74.
50. Kee WD, Khaw KS, Ma KC, Wong AS, Lee BB, Ng FF. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: A randomized, double-blind, controlled trial. Anesthesiology. 2006;104: 14-20.
51. INVIMA. Sala especializada de medicamentos y productos biológicos de la comisión revisora del Instituto Nacional de Vigilancia de Medicamentos y Alimentos. Sesión Extraordinaria -Virtual, Subtítulo: Ultiva, Inyectable. 2009; 19-22.
52. Wetterslev J, Thorlund K, Brok J, Gluud C. Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol. 2008;61:64-75.
How to Cite
1.
González Cárdenas VH, Munar González FD, Gómez Barajas WJ, Cardona AM, Rafael Rosero B, Manrique Álvaro J. Remifentanil vs. epidural analgesia for the management of acute pain associated with labour. Systematic review and meta-analysis. Colomb. J. Anesthesiol. [Internet]. 2014 Oct. 1 [cited 2022 Dec. 2];42(4):281-94. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/243

Downloads

Download data is not yet available.
Published
2014-10-01
How to Cite
1.
González Cárdenas VH, Munar González FD, Gómez Barajas WJ, Cardona AM, Rafael Rosero B, Manrique Álvaro J. Remifentanil vs. epidural analgesia for the management of acute pain associated with labour. Systematic review and meta-analysis. Colomb. J. Anesthesiol. [Internet]. 2014 Oct. 1 [cited 2022 Dec. 2];42(4):281-94. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/243
Section
Original