Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia:a randomised equivalence trial

Autor: Owhm Borchert, E. J. R. Van Beek, Esa van den Akker, M.B. Godfried, Nico W.E. Schuitemaker, Corine Verhoeven, Ben W.J. Mol, Ecsm van Woerkens, Liv M. Freeman, J.A.M. van der Post, Johanna M. Middeldorp, I. Hostijn, K. Oude Rengerink, Slm Logtenberg
Přispěvatelé: ARD - Amsterdam Reproduction and Development, Obstetrics and Gynaecology, APH - Methodology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), Midwifery Science
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Adult
medicine.medical_specialty
Labour pain
Visual analogue scale
Epidural analgesia
medicine.medical_treatment
Population
Remifentanil
satisfaction with pain relief
remifentanil patient-controlled analgesia
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
Pregnancy
Clinical endpoint
Journal Article
Medicine
Humans
Pain Management
030212 general & internal medicine
education
labour pain
Netherlands
Pain Measurement
Labor Pain
education.field_of_study
Labor
Obstetric
business.industry
Patient-controlled analgesia
Area under the curve
Obstetrics and Gynecology
Analgesia
Patient-Controlled
pain satisfaction score
Analgesia
Epidural
Analgesics
Opioid
pain intensity score
Equivalence Trial
Patient Satisfaction
Anesthesia
Area Under Curve
Physical therapy
Analgesia
Obstetrical
Female
business
medicine.drug
Zdroj: Logtenberg, S L M, Oude Rengerink, K, Verhoeven, C J, Freeman, L M, van den Akker, E S A, Godfried, M B, van Beek, E, Borchert, O W H M, Schuitemaker, N, van Woerkens, E C S M, Hostijn, I, Middeldorp, J M, van der Post, J A & Mol, B W 2017, ' Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia : a randomised equivalence trial ', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 124, no. 4, pp. 652-660 . https://doi.org/10.1111/1471-0528.14181
BJOG, 124(4), 652-660. Wiley-Blackwell
BJOG: An International Journal of Obstetrics and Gynaecology, 124(4), 652-660
BJOG: An International Journal of Obstetrics and Gynaecology, 124(4), 652-660. Wiley Online Library
BJOG-An International Journal of Obstetrics and Gynaecology, 124(4), 652. Wiley-Blackwell
ISSN: 1470-0328
Popis: Objective: To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women. Design: Randomised controlled equivalence trial. Setting: Eighteen midwifery practices and six hospitals in the Netherlands. Population: A total of 408 pregnant women at low risk for obstetric complications initially under the care of primary-care midwives. Methods: Women randomised before active labour to receive analgesia with RPCA or EA, if requested. Main outcome measures: Primary outcome was satisfaction with pain relief measured hourly using a visual analogue scale and summed as area under the curve (AUC). Secondary outcomes were overall satisfaction with pain relief, pain intensity scores during labour, mode of delivery, and maternal and neonatal outcomes. Results: We randomised 418 women, of whom 409 could be followed for the primary endpoint. Analgesia was received by 46% (94/203) in the remifentanil group and 37% (76/206) in the epidural group. The AUC for satisfaction with pain relief was 32 in the remifentanil group and 31 in the epidural group (mean difference −0.50; 95% CI −6.8 to 5.9). Among women who actually received analgesia, these values were 23 and 35, respectively (mean difference −12; 95% CI −22 to −1.5). Secondary outcomes were comparable. Conclusions: In low-risk labouring women, we could not demonstrate equivalence between a strategy with RPCA to EA with respect to satisfaction with pain relief assessed during the total duration of labour. However, once applied satisfaction was higher in women who received epidural analgesia. Tweetable abstract: Satisfaction with pain relief is higher in women receiving epidural analgesia compared with Remifentanil PCA.
Databáze: OpenAIRE
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