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Retrospective evaluation of intravenous fentanyl patient-controlled analgesia during labor

Journal of Anesthesia volume 26, pages 219–224 (2012)Cite this article

Abstract

Purpose

Because the safety of intravenous fentanyl patient-controlled analgesia (iv-PCA) administered during labor remains unclear, we retrospectively examined the labor records from January 2005 to December 2007 in our institution, with a focus on both maternal and neonatal outcomes, as compared to no analgesia.

Methods

Parturients over 35 weeks of gestational age who received fentanyl iv-PCA (iv-PCA group) or no analgesia (control group) during labor were enrolled. The former group received iv-PCA through a pump programmed to give a loading dose of 0.05 mg fentanyl, followed by bolus injection of 0.02 mg fentanyl, with a lock-out interval of 5 min. This analgesia was initiated at the parturient’s request and was discontinued before the second stage of labor, to ensure neonatal safety. During labor, both maternal and fetal heart rates, maternal pulse oximeter oxygen saturation (SpO2), respiratory rate, and sedation and nausea scores were continuously monitored, and the neonatal outcomes including umbilical arterial pH, Apgar scores, and other parameters were recorded.

Results

The data of 129 of the 143 parturients who received fentanyl iv-PCA were analyzed, while 697 parturients delivered without any analgesia during the 3-year study period. While iv-PCA prolonged the duration of labor and increased oxytocin use, no obvious maternal or neonatal complications of fentanyl use were recorded. Except for the significantly lower rate of emergency cesarean section in the iv-PCA group, both the maternal and neonatal outcomes were comparable between the groups.

Conclusions

As compared to no analgesia, fentanyl iv-PCA appears to be safe and clinically acceptable as analgesia during labor, particularly in nulliparous women.

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References

  1. Camann W. Pain relief during labor. N Engl J Med. 2005;352:718–20.

    PubMed  Article  CAS  Google Scholar 

  2. Fun W, Lew E, Sia AT. Advances in neuraxial blocks for labor analgesia: new techniques, new systems. Minerva Anesthesiol. 2008;74:77–85.

    CAS  Google Scholar 

  3. Goetzl LM, ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin. Clinical Management Guideline for Obstetrician-Gynecologists Number 36, July 2002. Obstetric analgesia and anesthesia. Obstet Gynecol. 2002;100:177–91.

    PubMed  Article  Google Scholar 

  4. Hill D. The use of remifentanil in obstetrics. Anesthesiol Clin. 2008;26:169–82.

    PubMed  Article  CAS  Google Scholar 

  5. Halpern SH, Muir H, Breen TW, Breen TW, Campbell DC, Barrett J, Liston R, Blanchard JW. A multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor. Anesth Analg. 2004;99:1532–8.

    PubMed  Article  CAS  Google Scholar 

  6. Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. BJOG. 2002;109:1344–53.

    PubMed  Google Scholar 

  7. Gouyon JB, Vintejoux A, Sagot P, Burguet A, Quantin C, Fredynus C, the Burgundy Perinatal Network. Neonatal outcome associated with singleton birth at 34–41 weeks of gestation. Int J Epidemiol. 2010;39:769–76.

    PubMed  Article  Google Scholar 

  8. Nikkola EM, Ekblad UU, Kero PO, Alihanka JJ, Salonen MA. Intravenous fentanyl PCA during labour. Can J Anaesth. 1997;44:1248–55.

    PubMed  Article  CAS  Google Scholar 

  9. Victory R, Penava D, Da Silva O, Natale R, Richardson B. Umbilical cord pH and base excess values in relation to adverse outcome events for infants delivering at term. Am J Obstet Gynecol. 2004;191:2021–8.

    PubMed  Article  CAS  Google Scholar 

  10. Sheiner E, Shoham-Vardi I, Hershkovitz R, Katz M, Mazor M. Infertility treatment is an independent risk factor for cesarean section among nulliparous women aged 40 and above. Am J Obstet Gynecol. 2001;185:888–92.

    PubMed  Article  CAS  Google Scholar 

  11. Lowe NK. The nature of labor pain. Am J Obstet Gynecol. 2002;186:S16–24.

    PubMed  Google Scholar 

  12. Rosaeg OP, Kitts JB, Koren G, Byfold LJ. Maternal and fetal effects of intravenous patient-controlled fentanyl analgesia during labour in a thrombocytopenic parturient. Can J Anaesth. 1992;39:277–81.

    PubMed  Article  CAS  Google Scholar 

  13. Scott JC, Ponganis KV, Stanski DR. EEG quantification of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology. 1985;62:234–41.

    PubMed  Article  CAS  Google Scholar 

  14. Olofsson C, Ekblom A, Ekman-Ordeberg G, Hjelm A, Irestedt L. Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. Br J Obstet Gynecol. 1996;103:968–72.

    Article  CAS  Google Scholar 

  15. Reynolds F, Crowhurst JA. Opioids in labour—no analgesic effect. Lancet. 1997;349:4–5.

    PubMed  Article  CAS  Google Scholar 

  16. Nelson KE, Eisenach JC. Intravenous butorphanol, meperidine, and their combination relieve pain and distress in women in labor. Anesthesiology. 2005;102:1008–13.

    PubMed  Article  CAS  Google Scholar 

  17. Liu EH, Sia AT. Rates of cesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusion or opioid analgesia: systematic review. BMJ. 2004;328:1410–5.

    PubMed  Article  CAS  Google Scholar 

  18. Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A. Effect of epidural vs. parenteral opioid analgesia on the progress of labor: a meta analysis. JAMA. 1998;280:2105–10.

    PubMed  Article  CAS  Google Scholar 

  19. Rayburn WF, Smith CV, Parriott JE, Woods RE. Randomized comparison of meperidine and fentanyl during labor. Obstet Gynecol. 1989;74:604–6.

    PubMed  CAS  Google Scholar 

  20. Jonsson M, Norden-Lindeberg S, Ostlund I, Hanson U. Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor. Acta Obstet Gynecol Scand. 2008;87:745–50.

    PubMed  Article  Google Scholar 

  21. Morley-Forster PK, Weberpals J. Neonatal effect of patient-controlled analgesia using fentanyl in labor. Int J Obstet Anesth. 1998;7:103–7.

    PubMed  Article  CAS  Google Scholar 

  22. Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT, Yaghmour E, Marcus RJL, Sherwani SS, Sproviero MT, Yilmaz M, Patel R, Robles C, Grouper S. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med. 2005;352:655–65.

    PubMed  Article  CAS  Google Scholar 

  23. Sharma SK, McIntire DD, Wiley J, Leveno KJ. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology. 2004;100:142–8.

    PubMed  Article  Google Scholar 

  24. Evron S, Ezri T. Options for systemic labor analgesia. Curr Opin Anaesthesiol. 2007;20:181–5.

    PubMed  Article  Google Scholar 

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Author information

Affiliations

  1. Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Yuki Hosokawa, Hiroshi Morisaki, Itsuo Nakatsuka, Saori Hashiguchi & Junzo Takeda

  2. Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Kei Miyakoshi, Mamoru Tanaka & Yasunori Yoshimura

Authors
  1. Yuki Hosokawa
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  2. Hiroshi Morisaki
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  3. Itsuo Nakatsuka
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  4. Saori Hashiguchi
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  5. Kei Miyakoshi
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  6. Mamoru Tanaka
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  7. Yasunori Yoshimura
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  8. Junzo Takeda
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Corresponding author

Correspondence to Hiroshi Morisaki.

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Hosokawa, Y., Morisaki, H., Nakatsuka, I. et al. Retrospective evaluation of intravenous fentanyl patient-controlled analgesia during labor. J Anesth 26, 219–224 (2012). https://doi.org/10.1007/s00540-011-1292-3

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  • DOI: https://doi.org/10.1007/s00540-011-1292-3

Keywords

  • Labor analgesia
  • Fentanyl
  • Intravenous patient-controlled analgesia