Advertisement

Canadian Journal of Anaesthesia

, Volume 47, Issue 2, pp 113–119 | Cite as

A comparison of patient-controlled analgesia fentanyl and alfentanil for labour analgesia

  • Patricia K. Morley-Forster
  • Donald W. Reid
  • Hilde Vandeberghe
Reports Of Investigation

Abstract

Purpose: To determine the analgesic efficacy of equipotent doses of PCA (patient-controlled analgesia) fentanyl and PCA alfentanil for labour pain.

Methods: Twenty three, ASA I–II parturients between 32–42 wk gestational age in whom epidural analgesia was contraindicated were randomized to receive PCA fentanyl (Group F) or alfentanil (Group A). Plain numbered vials contained 21 ml fentanyl 50 µg·ml−1 or alfentanil 500 µg·ml−1. A one millilitre loading dose was administered. The PCA solution was prepared by diluting 10 ml study drug with 40 ml saline and the PCA pump was programmed to deliver a dose of 2 ml, delay of five minutes and a basal rate of 2 ml·hr−1. Maternal measurements obtained were hourly drug dose, total dose, Visual Analog Pain Score (VAPS) q 30 min, sedation score q 1 hr and side effects. Neonates were assessed by 1,5, and 10-min Apgar scores, umbilical venous and arterial blood gases and neurobehavioural scores at four and 24 hr.

Results: Mean VAPS from 7 – 10 cm cervical dilatation were higher in Group A than in Group F. (85.7±13.9vs 64.6±12.1;P<0.01) There were no inter-group differences in VAPS from 1–3 cm, or from 4–6 cm dilatation, in maternal sedation scores or side effects, or in neonatal outcomes.

Conclusion: In the doses prescribed in this study, PCA fentanyl was found to provide more effective analgesia in late first stage labour than PCA alfentanil.

Keywords

Fentanyl Epidural Analgesia Alfentanil Cervical Dilatation Visual Analog Pain Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Déterminer l’efficacité analgésique de doses équivalentes de fentanyl ACP (analgésie contrôlée par le patient) et d’alfentanil ACP pendant le travail obstétrical.

Méthode: Vingt-trois parturientes, ASA I–II, de 32 à 42 sem de grossesse, réparties au hasard et pour qui l’analgésie péridurale était contre-indiquée, ont reçu du fentanyl (groupe F) ou de l’alfentanil (groupe A) ACP. Le contenu de flacons simples, numérotés, de 21 ml de fentanyl à 50 µg·ml−1 ou d’alfentanil à 500 µg·ml−1 et un millilitre de dose de charge ont été administrés. La solution d’ACP comportait 10 ml du médicament à l’étude dilués dans 40 ml de solution salée et la pompe d’ACP a été programmée pour une dose de 2 ml, un délai de cinq minutes et une vitesse de base de 2 ml·hr−1. On a fait les mesures suivantes: la dose de médicament à chaque heure, la dose totale, le score de l’échelle visuelle analogique (SEVA) aux 30 min, le score de sédation aux heures et les effets secondaires. Chez les nouveau-nés on a noté l’indice d’Apgar à 1, 5 et 10 min, les gaz du sang artériel et veineux du cordon et les scores neurologiques à 4 h et 24 h.

Résultats: Les SEVA moyens pour une dilatation cervicale de 7–10 cm ont été plus élevés dans le groupe A que dans le groupe F (85,7±13,9vs 64,6±12,1;P<0,01). Il n’y a pas eu de différence intergroupe concernant les SEVA pour une dilatation de 1–3 cm ou de 4–6 cm, les scores de sédation de la mère ou les effets secondaires, ou l’évolution des nouveau-nés.

Conclusion: Selon les doses prescrites dans notre étude, le fentanyl ACP a été un analgésique plus efficace, à la fin du premier stade du travail obstétrical, que l’alfentanil ACP.

References

  1. 1.
    Rayburn WF, Smith CV, Parriott JE, Woods RE. Randomized comparison of meperidine and fentanyl during labor. Obstet Gynecol 1989; 74: 604–6.PubMedGoogle Scholar
  2. 2.
    Kleiman SJ, Wiesel S, Tessler MJ. Patient-controlled analgesia (PCA) using fentanyl in a parturient with a platelet function abnormality. Can J Anaesth 1991; 38: 489–91.PubMedGoogle Scholar
  3. 3.
    Rosaeg OP, Kitts JB, Koren G, Byford LJ. Maternal and fetal effects of intravenous patient-controlled fentanyl analgesia during labour in a thrombocytopenic parturient. Can J Anaesth 1992; 39: 277–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Nikkola EM, Ekblad UU, Kero PO, Alihanka JJM, Salonen MAO. Intravenous fentanyl PCA during labour. Can J Anaesth 1997; 44: 1248–55.PubMedGoogle Scholar
  5. 5.
    Scott JC, Ponganis KV, Stanski DR. EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 1985; 62: 234–41.PubMedGoogle Scholar
  6. 6.
    Zelcer J, White PF, Chester S, Paull JD, Molnar R Intraoperative patient-controlled analgesia: an alternative to physician administration during outpatient monitored anesthesia care. Anesth Analg 1992; 75: 41–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Barash PG, Cullen BF, Stoelting RK Clinical Anesthesia, 2nd ed. Philadelphia: J.B. Lippincott Company, 1992: 417.Google Scholar
  8. 8.
    Amiel-Tison C, Barrier G, Shnider SM, Levinson G, Hughes SC, Stefani SJ. A new neurologic and adaptive capacity scoring system for evaluating obstetric medications in full-term newborns. Anesthesiology 1982; 56: 340–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Vandeberghe H. Feasibility of quantitation of serum alfentanil using a qualitative kit. Abstracts Fifth International Congress of Therapeutic Drug Monitoring and Clinical Toxicology 1997: Vancouver.Google Scholar
  10. 10.
    Gourlay GK, Kowalski SR, Plummer JL, Cousins MJ, Armstrong PJ. Fentanyl blood concentration — analgesic response relationship in the treatment of postoperative pain. Anesth Analg 1988; 67: 329–37.PubMedCrossRefGoogle Scholar
  11. 11.
    Lehmann KA, Ribbert N, Horrichs-Haermeyer G Postoperative patient-controlled analgesia with alfentanil: analgesic efficacy and minimum effective concentrations. J Pain Symptom Manage 1990; 5: 249–58.PubMedCrossRefGoogle Scholar
  12. 12.
    White PF, Coe V, Shafer A, Sung M-L. Comparison of alfentanil with fentanyl for outpatient anesthesia. Anesthesiology 1986; 64: 99–106.PubMedCrossRefGoogle Scholar
  13. 13.
    Bovill JG, Sebel PS, Blackburn CL, Heykants J. The pharmacokinetics of alfentanil (R39209): a new opioid analgesic. Anesthesiology 1982; 57: 439–43.PubMedCrossRefGoogle Scholar
  14. 14.
    Hull CJ. The pharmacokinetics of alfentanil in man. Br J Anaesth 1983; 55: 157S-64.PubMedCrossRefGoogle Scholar
  15. 15.
    Chauvin M, Hongnat JM, Mourgeon E, Lebrault C, Bellenfant F, Alfonsi P. Equivalence of postoperative analgesia with patient-controlled intravenous or epidural alfentanil. Anesth Analg 1993; 76: 1251–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Gepts E, Heytens L, Camu F. Pharmacokinetics and placental transfer of intravenous and epidural alfentanil in parturient women. Anesth Analg 1986; 65: 1155–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Morley-Forster PK, Weberpals J. Neonatal effects of patient-controlled analgesia using fentanyl in labor. Int J Obstet Anesth 1998; 7: 103–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Muir HA, Breen T, Campbell DC, Halpern S, Blanchard W. Is intravenous PCA fentanyl an effective method for providing labor analgesia? Abstracts of the Society of Obstetric Anesthesia and Perinatology 1999: A28.Google Scholar

Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Patricia K. Morley-Forster
    • 1
  • Donald W. Reid
    • 1
  • Hilde Vandeberghe
    • 1
  1. 1.From the Departments of Anaesthesia and Neonatology, St. Joseph’s Health CentreUniversity of Western OntarioCanada

Personalised recommendations