Abstract
Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world. Intravenous patient-controlled analgesia (IVPCA) with remifentanil is considered to be a reasonable option for labor pain relief. Several studies have demonstrated its efficacy with minimal maternal and neonatal adverse effects. On the other hand, reports of cases of maternal cardiac and respiratory arrest with remifentanil IVPCA within the past couple of years have redirected our attention to its safe use. Remifentanil IVPCA warrants one-to-one nursing monitoring, appropriate education of healthcare providers, continuous maternal oxygen saturation monitoring, end-tidal CO2 monitoring, and availability of both maternal and neonatal resuscitation equipment. This article provides an overview of knowledge and principles of using remifentanil IVPCA for labor analgesia and introduces its potential usage in Japan.
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References
Terui K. Comparison of the obstetric anesthesia practice between Japan and USA. Masui. 2009;58(11):1473–5.
Devabhakthuni S. Efficacy and safety of remifentanil as an alternative labor analgesic. Clin Med Insights Womens Health. 2013;6:37–49.
Rooks JP. Labor pain management other than neuraxial: what do we know and where do we go next? Birth. 2012;39(4):318–22.
Lowe NK. The nature of labor pain. Am J Obstet Gynecol. 2002;186(5 (Suppl Nature):S16–24.
Pan PH, Eisenach JC. The pain of childbirth and its effects on the mother and the fetus. In: Chestnut DH, Polley L, Tsen LC, Wong CA, editors. Chestnut’s obstetric anesthesia: principles and practice. 4th ed. Philadelphia: Mosby Elsevier; 2009. p. 387–403.
Melzack R. The myth of painless childbirth. Pain. 1984;19(4):321–37.
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(3):606–8.
Kapila A, Glass PS, Jacobs JR, Muir KT, Hermann DJ, Shiraishi M, Howell S, Smith RL. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology. 1995;83(5):968–75.
Thompson JP, Rowbotham DJ. Remifentanil—an opioid for the 21st century. Br J Anaesth. 1996;76(3):341–3.
Douma M. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth. 2010;104(2):209–15.
Marwah R, Hassan S, Carvalho JC, Balki M. Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study. Can J Anesth. 2012;59(3):246–54.
Volmanen P, Sarvela J, Akural EI, 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.
Douma MR, Middeldorp JM, Verwey RA, Dahan A, Stienstra R. A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour. Int J Obstet Anesth. 2011;20(2):118–23.
Tveit TO, Seiler S, Halvorsen A, Rosland JH. Labour analgesia: a randomised, controlled trial comparing intravenous remifentanil and epidural analgesia with ropivacaine and fentanyl. Eur J Anaesth. 2012;29(3):129–36.
Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014;118(3):589–97.
Leong WL, Sng BL, Sia AT. A comparison between remifentanil and meperidine for labor analgesia: a systematic review. Anesth Analg. 2011;113(4):818–25.
Schnabel A, Hahn N, Broscheit J, Muellenbach RM, Rieger L, Roewer N, Kranke P. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol. 2012;29(4):177–85.
Hinova A, Fernando R. Systemic remifentanil for labor analgesia. Anesth Analg. 2009;109(6):1925–9.
Liu ZQ, Chen XB, Li HB, Qiu MT, Duan T. A comparison of remifentanil parturient-controlled intravenous analgesia with epidural analgesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118(3):598–603.
Stourac P, Suchomelova H, Stodulkova M, Huser M, Krikava I, Janku P, Haklova O, Hakl L, Stoudek R, Gal R, Sevcik P. Comparison of parturient-controlled remifentanil with epidural bupivacaine and sufentanil for labour analgesia: randomised controlled trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012;156:227–32.
Ismail MT, Hassanin MZ. Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women. Arch Gynecol Obstet. 2012;286:1375–81.
Blair JM, Hill DA, Fee JP. Patient-controlled analgesia for labour using remifentanil: a feasibility study. Br J Anaesth. 2001;87(3):415–20.
Volmanen P, Akural EI, Raudaskoski T, Alahuhta S. Remifentanil in obstetric analgesia: a dose-finding study. Anesth Analg. 2002;94(4):913–7.
Tveit TO, Halvorsen A, Seiler S, Rosland JH. Efficacy and side effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study. Int J Obstet Anesth. 2013;22(1):19–25.
Balki M, Kasodekar S, Dhumne S, Bernstein P, Carvalho JC. Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens. Can J Anesth. 2007;54(8):626–33.
D’Onofrio P, Novelli AM, Mecacci F, Scarselli G. The efficacy and safety of continuous intravenous administration of remifentanil for birth pain relief: an open study of 205 parturients. Anesth Analg. 2009;109(6):1922–4.
Shen MK, Wu ZF, Zhu AB, He LL, Shen XF, Yang JJ, Feng SW. Remifentanil for labour analgesia: a double-blinded, randomised controlled trial of maternal and neonatal effects of patient-controlled analgesia versus continuous infusion. Anaesthesia. 2013;68(3):236–44.
Schwarz GL, Volmanen P, Albrechtsen S, Bjoernestad E. Remifentanil target-controlled infusion during second stage labour in high-risk parturients: a case series. Acta Anaesthesiol Scand. 2013;57(6):802–8.
Sia AT, Sng BL, Leo S. Novel vital signs-controlled, patient-assisted intravenous analgesia using remifentanil for labour and delivery. Int J Obstet Anesth. 2014;23(2):196–8.
Bonner JC, McClymont W. Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2012;67(5):538–40.
Marr RHJ, Bythell V. Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2013;68(3):283–7.
Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014;118:589–97.
Konefał H, Jaskot B, Czeszyńska MB, Pastuszka J. Remifentanil patient-controlled analgesia for labor–monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after delivery. Arch Med Sci. 2013;9(4):697–702.
Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol. 2002;186:S160–72.
Volmanen PVE, Akural EI, Raudaskoski T, Ranta P, Tekay A, Ohtonen P, Alahuhta S. Timing of intravenous patient-controlled remifentanil bolus during early labour. Acta Anaesthesiol Scand. 2011;55(4):486–94.
Evron S, Glezerman M, Sadan O, Boaz M, Ezri T. Remifentanil: a novel systemic analgesic for labor pain. Anesth Analg. 2005;100:233–8.
Volikas I, Male D. A comparison of pethidine and remifentanil patient-controlled analgesia in labour. Int J Obstet Anesth. 2001;10:86–90.
Thurlow BA, Laxton CH, Dick A, Waterhouse P, Sherman L, Goodman NW. Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief I labour. Br J Anaesth. 2002;88:374–8.
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(4):504–9.
Blair JM, Dobson GT, Hill DA, McCracken GR, Fee JPH. Patient controlled analgesia for labour: a comparison of remifentanil with pethidine. Anaesthesia. 2005;60:22–7.
Thurlow JA, Waterhouse P. Patient-controlled analgesia in labour using remifentanil in two parturients with platelet abnormalities. Br J Anaesth. 2000;84(3):411–3.
Jones R, Pregrum A, Stacey GW. Patient-controlled analgesia using remifentanil in the parturient with thrombocytopaenia. Anaesthesia. 1999;54:459–65.
Balcioglu O, Akin S, Demir S, Aribogan A. Patient-controlled intravenous analgesia with remifentanil in nulliparous subjects in labor. Expert Opin Pharmacother. 2007;8(18):3089–96.
Roelants F, Franceschi ED, Veyckemans F, Lavand’homme P. Patient-controlled intravenous analgesia using remifentanil in the parturient. Can J Anesth. 2001;48(2):175–8.
Owen MD, Poss MJ, Dean LS, Harper MA. Prolonged intravenous remifentanil infusion for labor analgesia. Anesth Analg. 2002;94(4):918–9.
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An erratum to this article is available at http://dx.doi.org/10.1007/s00540-016-2269-z.
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Ohashi, Y., Baghirzada, L., Sumikura, H. et al. Remifentanil for labor analgesia: a comprehensive review. J Anesth 30, 1020–1030 (2016). https://doi.org/10.1007/s00540-016-2233-y
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DOI: https://doi.org/10.1007/s00540-016-2233-y