Seguridad y eficacia del remifentanilo por vía intravenosa mediante un sistema de analgesia controlada por la paciente durante el trabajo de parto
Jose Novoa Apumayta, Sergio Rodriguez Benavides
Actas Peruanas de Anestesiología
http://sisbib.unmsm.edu.pe/BVRevistas/actas_anestesiologia/v20n2/
pdf/a03v20n2.pdf
Analgesia con remifentanil controlada por el pacientes versus analgesia epidural en trabajo de parto. Estudio multicéntrico aleatorizado y controlado
Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial.
Freeman LM, Bloemenkamp KW, Franssen MT, Papatsonis DN, Hajenius PJ, van Huizen ME, Bremer HA, van den Akker ES, Woiski MD, Porath MM, van Beek E, Schuitemaker N, van der Salm PC, Fong BF, Radder C, Bax CJ, Sikkema M, van den Akker-van Marle ME, van Lith JM, Lopriore E, Uildriks RJ, Struys MM, Mol BW, Dahan A, Middeldorp JM.
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands. l.m.freeman@lumc.nl
BMC Pregnancy Childbirth. 2012 Jul 2;12:63. doi: 10.1186/1471-2393-12-63.
Abstract
BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN: The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION: This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day.
TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR2551,http://www.trialregister.nl.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464937/pdf/1471-2393-12-63.pdf
Comparación entre remifentanil y meperidina en analgesia para trabajo de parto: revisión sistemática.
A comparison between remifentanil and meperidine for labor analgesia: a systematic review.
Leong WL, Sng BL, Sia AT.
Department of Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Rd., Singapore 228988. wlleong101@gmail.com
Anesth Analg. 2011 Oct;113(4):818-25. doi: 10.1213/ANE.0b013e3182289fe9. Epub 2011 Sep 2.
Abstract
BACKGROUND: Remifentanil is an ultrashort-acting opioid with favorable pharmacokinetic properties that make it suitable as a labor analgesic. Although it crosses the placenta freely, it is eliminated quickly in the neonate by rapid metabolism and redistribution. We aimed to determine whether remifentanil compared with meperidine is effective in reducing pain scores in laboring parturients. Other effects on the mother, the labor process, and the neonate were also examined. METHODS: MEDLINE, CINAHL, Embase, Cochrane CENTRAL, and Maternity and Infant Care databases were searched without language restriction using multiple keywords for labor analgesia, remifentanil, and meperidine. Published abstracts from 5 key research meetings and references from retrieved articles were examined for additional studies. Randomized controlled trials in laboring parturients comparing remifentanil with meperidine were selected. Risk of bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We assessed for adequacy of sequence generation, allocation concealment, blinding, and completeness of follow-up. Data were extracted from each study using a standardized data collection form. The primary outcome was reduction in pain scores (visual analog scale [VAS], 0-100 mm). We also evaluated maternal side effects (sedation, oxygen desaturation, and bradypnea) and effects on the neonate (Apgar scores, umbilical cord pH, and Neurologic and Adaptive Capacity Scores). RESULTS: Seven studies (349 patients) were identified for inclusion; only 3 studies were suitable for quantitative synthesis in a meta-analysis (233 patients). We found that remifentanil reduces the mean VAS score at 1 hour by 25 mm more than meperidine (P < 0.001) (95% confidence interval = 19-31 mm). Limited conclusions can be made regarding the side-effect profile of remifentanil because of insufficient data. CONCLUSION: Compared with meperidine, remifentanil is superior in reducing mean VAS scores for labor pain after 1 hour.
http://www.anesthesia-analgesia.org/content/113/4/818.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Jose Novoa Apumayta, Sergio Rodriguez Benavides
Actas Peruanas de Anestesiología
http://sisbib.unmsm.edu.pe/BVRevistas/actas_anestesiologia/v20n2/
pdf/a03v20n2.pdf
Analgesia con remifentanil controlada por el pacientes versus analgesia epidural en trabajo de parto. Estudio multicéntrico aleatorizado y controlado
Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial.
Freeman LM, Bloemenkamp KW, Franssen MT, Papatsonis DN, Hajenius PJ, van Huizen ME, Bremer HA, van den Akker ES, Woiski MD, Porath MM, van Beek E, Schuitemaker N, van der Salm PC, Fong BF, Radder C, Bax CJ, Sikkema M, van den Akker-van Marle ME, van Lith JM, Lopriore E, Uildriks RJ, Struys MM, Mol BW, Dahan A, Middeldorp JM.
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands. l.m.freeman@lumc.nl
BMC Pregnancy Childbirth. 2012 Jul 2;12:63. doi: 10.1186/1471-2393-12-63.
Abstract
BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN: The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION: This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day.
TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR2551,http://www.trialregister.nl.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464937/pdf/1471-2393-12-63.pdf
Comparación entre remifentanil y meperidina en analgesia para trabajo de parto: revisión sistemática.
A comparison between remifentanil and meperidine for labor analgesia: a systematic review.
Leong WL, Sng BL, Sia AT.
Department of Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Rd., Singapore 228988. wlleong101@gmail.com
Anesth Analg. 2011 Oct;113(4):818-25. doi: 10.1213/ANE.0b013e3182289fe9. Epub 2011 Sep 2.
Abstract
BACKGROUND: Remifentanil is an ultrashort-acting opioid with favorable pharmacokinetic properties that make it suitable as a labor analgesic. Although it crosses the placenta freely, it is eliminated quickly in the neonate by rapid metabolism and redistribution. We aimed to determine whether remifentanil compared with meperidine is effective in reducing pain scores in laboring parturients. Other effects on the mother, the labor process, and the neonate were also examined. METHODS: MEDLINE, CINAHL, Embase, Cochrane CENTRAL, and Maternity and Infant Care databases were searched without language restriction using multiple keywords for labor analgesia, remifentanil, and meperidine. Published abstracts from 5 key research meetings and references from retrieved articles were examined for additional studies. Randomized controlled trials in laboring parturients comparing remifentanil with meperidine were selected. Risk of bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We assessed for adequacy of sequence generation, allocation concealment, blinding, and completeness of follow-up. Data were extracted from each study using a standardized data collection form. The primary outcome was reduction in pain scores (visual analog scale [VAS], 0-100 mm). We also evaluated maternal side effects (sedation, oxygen desaturation, and bradypnea) and effects on the neonate (Apgar scores, umbilical cord pH, and Neurologic and Adaptive Capacity Scores). RESULTS: Seven studies (349 patients) were identified for inclusion; only 3 studies were suitable for quantitative synthesis in a meta-analysis (233 patients). We found that remifentanil reduces the mean VAS score at 1 hour by 25 mm more than meperidine (P < 0.001) (95% confidence interval = 19-31 mm). Limited conclusions can be made regarding the side-effect profile of remifentanil because of insufficient data. CONCLUSION: Compared with meperidine, remifentanil is superior in reducing mean VAS scores for labor pain after 1 hour.
http://www.anesthesia-analgesia.org/content/113/4/818.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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