Remifentanil Patient-Controlled Analgesia, Epidural Have Similar Pain Outcomes During Delivery

The authors of a systematic review and meta-analysis published in Plos One found that remifentanil patient-controlled analgesia was associated with similar pain relief and Apgar outcomes, less maternal fever, and more respiratory depression as epidural analgesia in the setting of labor and delivery.

Investigators from Zhejiang University in China searched publication databases through February 2022 for studies that compared the analgesic effects and safety outcomes of remifentanil patient-controlled analgesia and epidural analgesia during childbirth. Ten randomized controlled trials were included in this analysis.

According to the study authors, “Remifentanil is a synthetic new type of piperidine opioid μ receptor agonist, which has high-efficiency analgesia and can improve the onset speed and hydrolysis speed of anesthesia.”

The studies were published between 2008 and 2019 and were conducted in the Netherlands (n=3), China (n=2), Czech Republic (n=1), North Macedonia (n=1), Israel (n=1), Kuwait (n=1), and the United States (n=1).

The pooled study population consisted of 3086 pregnant patients, among whom 1549 received remifentanil patient-controlled analgesia and 1537 received epidural analgesia.

The rate of maternal fever within 1 hour of receiving analgesia during labor was significantly lower among recipients of remifentanil patient-controlled analgesia than recipients of epidural analgesia (odds ratio [OR], 0.43; 95% CI, 0.30-0.62; I², 39%; P <.001), and a similar trend was observed after 1 hour (OR, 0.42; 95% CI, 0.20-0.90; I², 55%; P =.03).

However, remifentanil patient-controlled analgesia was associated with a higher rate of respiratory depression compared with epidural analgesia (OR, 3.56; 95% CI, 2.45-5.16; I², 0%; P <.001).

Neither method of analgesia was favored for the outcome of patient satisfaction with pain relief (standardized mean difference [SMD], 0.03; 95% CI, -0.40 to 0.46; I², 94%; P =.90) or Apgar scores at 5 minutes (OR, 1.18; 95% CI, 0.71-1.96; I², 26%; P =.53).

Major limitations of this analysis include the high heterogeneity in some comparisons and the lack of sufficient data to perform subgroup analyses.

The authors of this study found evidence that pain and newborn outcomes were similar among patients who received either remifentanil patient-controlled analgesia or epidural analgesia for pain relief during labor and delivery. The rate of maternal fever was lower among patients receiving remifentanil patient-controlled analgesia, but the rate of respiratory depression was higher with this modality. Additional well-designed studies are therefore needed to determine the safety and efficacy of remifentanil patient-controlled analgesia in the setting of labor and delivery.