A comparison of intravenous remifentanil patient-controlled analgesia with combined spinal-epidural analgesia in multiparous women: a prospective observational study

Background The combined spinal-epidural analgesia (CSEA) proved useful in multiparous women on account of faster onset and better analgesia in the first 30 minutes compared to standard epidural analgesia. Remifentanil has a suitable pharmacological profile for labour analgesia. Fast set up, onset, and limited time efficacy may render it useful in multiparous women with a faster labour progression.Methods The prospective observational study was performed in multiparous women in their active phase of the first stage labour after their informed choice of either RPCA (n=80) or CSEA (n=82). The primary outcome was pain-relief assessed on a 11-point numerical rating scale. The secondary outcomes were with pain-relief satisfaction, adverse effects, labour progress and labour outcomes.Results CSEA provided significantly lower pain scores and a higher satisfaction rate compared to RPCA [3.9 (0.36) vs 2.6 (1.1), P<0.001]. Likewise, more patients from the CSEA group would choose the same technique for the next labour CSEA; 77 (95%) vs. RPCA; 65 (81%), P=0.003. No difference between the groups was observed in recommending the respective technique to others CSEA; 77 (95%) vs. RPCA; 72 (90%), P=0.118. No crossovers were observed in either group. RPCA was associated with desaturation, bradypnea and apnoea in 27 (34%), 17 (21%) and 20 (25%) respective cases. All recovered spontaneously upon verbal or tactile stimulation. No clinically important differences were noted in sedation level, labour progress and labour outcomes between the groups.Conclusions This prospective observational study has shown that despite inferior pain relief and satisfaction, the remifentanil acceptance in multiparous women was still high as the vast majority of them graded their satisfaction rate as high/very high. That can be attributed to the facts that women with previewed shorter labour were more likely to choose a less invasive opioid analgesic option which provides an element of personal control. Thus, given no difference in labour outcomes, remifentanil could be routinely offered to parous women as a labour analgesic option, provided rigorous adherence to the protocols and continuous supervision by midwifes are ensured. Trial registration The trial was registered at ClinicalTrials.gov on November 15, 2016 (ID NCT02963337)