Abstract
Purpose
To evaluate the usefulness of intravenous patient-controlled analgesia (PCA) fentanyl for labour analgesia, its effectiveness for maternal pain and safety for the fetus and newborn.
Methods
Twenty primigravidas were randomised to receive intravenous PCA fentanyl or epidural analgesia for labour pain. Maternal pain, heart rate and arterial oxyhaemoglobin saturation (SpO2) were monitored. Fetal and neonatal monitoring included cardiotocogram (CTG), APGAR, neurological scoring and static-charge-sensitive bed (SCSB) recording for 12 hr postnatally with ECG and SpO2. Fentanyl concentrations and pH of umbilical artery and vein were analysed.
Results
Initially, epidural analgesia was more effective (P = 0.01 ), and three patients in the fentanyl group were given epidural due to unsatisfactory pain relief. Overall satisfaction for analgesia did not differ between the groups. Maternal side-effects were more frequent in the fentanyl group (dizziness and tiredness most often,P = 0.0001). Severe side-effects were not reported. In CTG there were no differences between groups. All the newborns were healthy, APGAR and pH were normal. Naloxone was not used. Neurological scoring was similar in both groups. In 12 hr monitoring heart rate, breathing frequency and movement time were similar in both groups, but SpO2 was lower in the fentanyl group (P < 0.001 ). Umbilical cord fentanyl concentrations were low or beyond the detection limit.
Conclusion
Intravenous fentanyl can be used for labour analgesia with the doses reported here as an alternative to epidural analgesia. However, the fetus and neonate must be appropriately monitored. Naloxone and oxygen should be available if neonatal distress occurs.
Résumé
Objectif
Évaluer l’importance de l’analgésie intraveineuse auto-contrôlée (PCA) au fentanyl en analgésie obstétncale en tenant compte de son efficacité et de la sécurité foeto-maternelle.
Méthodes
Vingt pnmipares ont été assignées aléatoirement à recevoir soit du fentanyl intraveineux en PCA soit une analgésie épidurale dans le but de soulager la douleur de l’accouchement. La douleur maternelle, la fréquence cardiaque et la saturation arténelle (SpO2) ont été notées. Le monitorage foetal et néonatal incluait la cardiotocographie (CTG), le score d’APGAR, l’évaluation neurologique et l’enregistrement au lit sensible à la statique (SCSB) pendant 12 h après la naissance avec l’ÉCG ET la SpO2. La concentration de fentanyl et le pH de l’artère et de la veine ombilicales étaient mesurés.
Résultats
Initialement, l’analgésie épidurale s’est avérée plus efficace (P = 0,01 ) et trois patientes du groupe fentanyl ont dû accepter une analgésie épidurale à cause du manque de soulagement. La satisfaction globale en rapport avec l’analgésie n’a pas différé entre les groupes. Des effets maternels secondaires sans gravité sont survenus plus souvent dans le groupe fentanyl (surtout des étourdissements et de la fatigue,P = 0,0001 ). Le CTG n’a pas révélé de différences intergroupes. Tous les enfants sont nés en bon état avec des scores d’APGAR et des pH normaux. On n’a pas administré de naloxone. Lévaluation neurologique était identique dans les deux groupes. Après 12 h de monitorage de la fréquence cardiaque, la fréquence respiratoire et le temps de mouvement étaient identiques dans les deux groupes mais la SpO2 était plus basse dans le groupe fentanyl (P < 0,001 ). Les concentrations ombilicales de fentanyl étaient faibles ou impossible à déceler.
Conclusion
Pour l’analgésie de l’accouchement, on peut substituer le fentanyl intraveineux selon les doses utilisées à l’analgésie épidurale. Cependant, le foetus et le nouveau-né doivent être surveillés de près. Il faut avoir du naloxone ou de l’oxygène à portée de main pour traiter la détresse néonatale potentielle.
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Supported by funds from Instrumentarium Research Foundation, Finland and funds from Turku University Hospital, Finland.
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Nikkola, E.M., Ekblad, U.U., Kero, P.O. et al. Intravenous fentanyl PCA during labour. Can J Anaesth 44, 1248–1255 (1997). https://doi.org/10.1007/BF03012771
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DOI: https://doi.org/10.1007/BF03012771