Department of Anaesthesiology and Intensive Care, University Hospital of Münster, Oberdürrbacher Street 6, Münster, Germany.
Eur J Anaesthesiol. 2012 Apr;29(4):177-85. doi: 10.1097/EJA.0b013e32834fc260.
Remifentanil is a potent short-acting μ-opioid receptor agonist which is rapidly metabolised in the mother and fetus and may be ideal for labour analgesia.
To assess efficacy and safety of remifentanil compared with other analgesic techniques for labour pain.
We systematically searched the central register of controlled trials of the Cochrane Library (till August 2011) and MEDLINE (till August 2011).
Randomised controlled trials investigating efficacy and safety of remifentanil administered via a patient-controlled analgesia (PCA) device compared with any other analgesic technique for labour pain were included.
We finally included 12 randomised controlled trials (published from 2001 to 2011). Women treated with remifentanil had a lower risk of conversion to epidural analgesia (P < 0.001), a lower mean pain score after 1 h (P < 0.001) and had higher satisfaction scores (P < 0.05) in comparison with women receiving pethidine. Epidural analgesia decreased pain scores compared with remifentanil (P = 0.003). There was only a limited amount of data comparing remifentanil with nitrous oxide or fentanyl. Serious maternal or fetal adverse outcomes were not reported in these trials.
During labour, remifentanil-PCA provided superior analgesia and higher patient satisfaction compared with pethidine with a comparable degree of adverse events. Epidural analgesia provided superior pain relief in comparison with remifentanil. Due to a low number of reported adverse events, the safety issue of remifentanil use in labour remains an open question that needs to be addressed in future trials.
瑞芬太尼是一种强效的短效 μ 阿片受体激动剂，在母亲和胎儿中迅速代谢，可能是分娩镇痛的理想选择。
评估瑞芬太尼与其他镇痛技术在分娩疼痛方面的疗效和安全性。
我们系统地检索了 Cochrane 图书馆的对照试验中心登记处（截至 2011 年 8 月）和 MEDLINE（截至 2011 年 8 月）。
纳入比较瑞芬太尼通过患者自控镇痛（PCA）装置给药与任何其他分娩疼痛镇痛技术的疗效和安全性的随机对照试验。
我们最终纳入了 12 项随机对照试验（发表于 2001 年至 2011 年）。与接受哌替啶的女性相比，接受瑞芬太尼治疗的女性转为硬膜外镇痛的风险较低（P<0.001），1 小时后平均疼痛评分较低（P<0.001），满意度评分较高（P<0.05）。与瑞芬太尼相比，硬膜外镇痛降低了疼痛评分（P=0.003）。比较瑞芬太尼与笑气或芬太尼的数据有限。这些试验中没有报告严重的母亲或胎儿不良结局。
在分娩过程中，瑞芬太尼-PCA 与哌替啶相比提供了更好的镇痛效果和更高的患者满意度，不良反应发生率相当。与瑞芬太尼相比，硬膜外镇痛能更好地缓解疼痛。由于报告的不良事件数量较少，瑞芬太尼在分娩中的安全性问题仍然是一个悬而未决的问题，需要在未来的试验中解决。
