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Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To assess if there is a difference in duration of labor, the mode of delivery, average Visual Analog Scale (VAS) pain scores, maternal overall satisfaction with analgesia, side effects and neonatal outcomes in nulliparous women who received early labor analgesia with either epidural, patient-controlled IV analgesia (PCIA) with remifentanil or combined spinal–epidural (CSE) techniques.

Study design

This is a prospective randomized interventional study.

Subjects and methods

The study included 1,140 healthy nulliparous women (with term, singleton pregnancies) early in labor, requesting labor analgesia, during the period from September 2009 to August 2011 at TAIBA Hospital in Kuwait. The participants were randomized to receive either epidural analgesia (Group I), or PCIA with remifentanil (Group II) or CSE analgesia (Group III). The primary outcome was the rate of cesarean delivery.

Results

CSE analgesia was associated with a statistically highly significant decrease in labor duration (from analgesia to vaginal delivery), duration of latent and active phases of the first stage, and duration of the second stage of labor, average VAS pain scores, and a highest maternal overall satisfaction score with analgesia (P < 0.01) as compared to epidural analgesia or PCIA with remifentanil.

Conclusion

In terms of labor duration, average VAS pain scores, and maternal overall satisfaction score with analgesia, CSE analgesia is superior to that provided by epidural analgesia or PCIA with remifentanil for pain relief in early labor in nulliparous women. However, there were no differences in the mode of delivery, side effects or neonatal outcomes between the three techniques.

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Acknowledgments

The authors would like to thank labor ward nurses at the Obstetrics Unit of Taiba Hospital, Kuwait for their assistance in conducting the study.

Conflict of interest

We (the authors) declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt

    Mohamed Taha Ismail

  2. Department of Anesthesiology, Tanta University, Tanta, Egypt

    Maher Z. Hassanin

  3. Sabah Al-Salem Area, Block 2, Street 2. Al-Messila Towers, Tower No. 3, Flat No. 342, Mubarak Alkabeer Governoate , Kuwait

    Mohamed Taha Ismail

Authors
  1. Mohamed Taha Ismail
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  2. Maher Z. Hassanin
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Corresponding author

Correspondence to Mohamed Taha Ismail.

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Ismail, M.T., Hassanin, M.Z. Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women. Arch Gynecol Obstet 286, 1375–1381 (2012). https://doi.org/10.1007/s00404-012-2459-3

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  • DOI: https://doi.org/10.1007/s00404-012-2459-3

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