[Patient-controlled continuous epidural analgesia vs intravenous remifentanil infusion for labour anaesthesia]

Although epidural anaesthesia has become a standard method for labour analgesia all over the world, it is far from being ideal because of side effects and contraindications. Many alternative techniques have therefore been proposed, including the continuous infusion of remifentanil. Encouraged by positive reports, we compared the efficacy of patient-controlled remifentanil infusion (PCA) with patient-controlled continuous epidural analgesia (PCEA).

Fifty-two ASA I and II parturients were arbitrarily allocated, without randomisation, to two groups to receive PCEA with 0.125% bupivacaine and 0.2 microg kg(-1) fentanyl (basic infusion 1 mL h(-1), bolus 4 mL, lock-out time 15 min) or remifentanil PCA (0.2 microg kg(-1) bolus doses, without basic infusion, lock-out time 2 min). The intensity of pain was assessed using the VAS scale every 15 min in the PCEA group and every 10 min in the PCA group.

During the first two hours of labour, the VAS score was significantly lower in the PCEA group. Later there was no difference between the groups. The clinical status of the newborns was similar.

The results are difficult to interpret since there was no randomisation and parturients participated in decisions about allocation to one of the study groups. Analgesia provided by remifentanil was assessed as highly acceptable by the patients and the drug can be regarded as a safe alternative to epidural analgesia during labour.