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

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.

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.

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Correspondence to Patricia K. Morley-Forster.

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Morley-Forster, P.K., Reid, D.W. & Vandeberghe, H. A comparison of patient-controlled analgesia fentanyl and alfentanil for labour analgesia. Can J Anaesth 47, 113–119 (2000). https://doi.org/10.1007/BF03018845

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Keywords

  • Fentanyl
  • Epidural Analgesia
  • Alfentanil
  • Cervical Dilatation
  • Visual Analog Pain Score