Evaluation of the efficacy and safety of patient-controlled intravenous analgesia with remifentanil during labor

Objective This paper evaluates the efficacy and safety of patient-controlled analgesia (PCA) with remifentanil during labor. Methods From February 2017 to March 2018, a total of 201 cases of parturients who delivered in Second Affiliated Hospital of Nanjing Medical University and Nanjing Medical University Sir Run Run Hospital were enrolled as subjects. According to the analgesic techniques, the 201 parturients were divided into the PCIA Group (n=110), the Epidural Anesthesia Group (n=35) and the Control Group (n=56). The parameters include pain scale of parturients, which is the scale of the Chinese version of the Short Form-McGill Pain Questionnaire (SF-MPQ), side effects, the vital signs during labor, rate of caesarean section, the newborns' one-minute and five-minute Apgar Score, and the DST result of newborns' at infancy stage. Results In comparison to the Control Group, there was a significant decrease of pain scores both in the Remifentanil Group and the Epidural Group(all P<0.05), but with higher pain scores in the Remifentanil Group. After the administration of the medication, subjects in both the Remifentanil group and the Epidural group experienced lowering in blood pressure, especially those in the Epidural group, and the difference was statistically significant (all P<0.05). Since epidural analgesia is more effective in pain relief than remifentanil, its administration is more effective in decreasing the risk of pain-induced hypertension during labor. But Epidural analgesia could extend the duration of the second stage of the labor. Compared with the PCIA Group and the control group, The duration in the Epidural Group is statistically significantly longer (all P<0.05). The incidence of side effects in Epidural Group was far higher than that in the other two groups, and the difference was statistically different(all P<0.05).There was no significant difference in the vital signs, the cesarean section rate, and forceps delivery rate among all three groups. There was no significant in the 1min Apgar score and 5min Apgar score of the newborns(all P>0.05) among all three groups. In addition, there was no significant difference in the newborns' the DST result(all P>0.05). Conclusion Compared to epidural anesthesia, which has more advanced analgesic effect, the patient-controlled intravenous analgesia with remifentanil, as a new analgesic technique, is still an effective and safe procedure which significantly relieves pain, has less impact on the duration of the second stage of labor, has less side effects on the parturients, and is simple to operate.