Patient-Directed IV Remifentanil Cuts Epidural Conversions

Patient-controlled remifentanil reduces proportion of conversions vs intramuscular pethidine.
Patient-controlled remifentanil reduces proportion of conversions vs intramuscular pethidine.

HealthDay News — Compared with intramuscular pethidine, use of intravenous remifentanil patient-controlled analgesia (PCA) in labor reduces the proportion of epidural conversions, according to a study published in the August 25 issue of The Lancet.

Matthew J.A. Wilson, MD, from the University of Sheffield in the United Kingdom, and colleagues conducted a multicenter randomized trial in 14 UK maternity units. Women beyond 37 weeks of gestation, in labor with a singleton cephalic presentation, who requested opioid pain relief were randomized to intravenous remifentanil PCA (201 women) or intramuscular pethidine (199 women). The proportion of women who received epidural analgesia after enrollment for pain relief in labor was assessed as the primary outcome. 

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The researchers found that the proportions of epidural conversion were 19 and 41% in the remifentanil PCA and pethidine groups, respectively (risk ratio, 0.48). During the study there were no serious adverse events or drug reactions directly attributable to either analgesic.

"Intravenous remifentanil PCA halved the proportion of epidural conversions compared with intramuscular pethidine," the authors write. "This finding challenges routine pethidine use as standard of care in labor."

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