Belfast City Hospital, Belfast, N. Ireland, UK.
Ulster Hospital, Dundonald, N. Ireland, UK.
Int J Obstet Anesth. 2019 Aug;39:29-34. doi: 10.1016/j.ijoa.2019.05.012. Epub 2019 Jun 5.
Intravenous remifentanil patient-controlled analgesia (PCA) has been routinely available for labouring women in our unit since 2004, the regimen using a 40 µg bolus available two minutely on demand, continuous pulse oximetry and mandatory one-to-one care. We examined remifentanil use and compared, with the other analgesic options available in our unit, outcomes such as mode of delivery, Apgar scores, neonatal resuscitation and admission to the neonatal intensive care unit.
We retrospectively identified women who delivered in our unit between 2005 and 2014 and received remifentanil, diamorphine or epidural analgesia during labour. Data were drawn from the Northern Ireland Maternity System electronic database, which records birth details from all obstetric units in Northern Ireland. Additional data were identified from paper survey forms, completed by the midwife post delivery for all women who received remifentanil in our unit. Outcomes were compared between women who received remifentanil, diamorphine or an epidural technique for labour analgesia.
Over the 10-year period, remifentanil was the most popular form of analgesia, being selected by 31.9% (8170/25617) women. Compared with women selecting diamorphine or epidural analgesia, those having remifentanil had similar rates of instrumental and operative delivery. Neonatal Apgar scores were also similar. Neonatal resuscitation or neonatal unit admission were not more likely in women choosing remifentanil PCA.
We found remifentanil PCA to be neither less safe nor associated with poorer outcomes than other analgesic options offered in our unit, when used within our guidelines for more than a 10-year period.
自 2004 年以来，我们单位的产妇一直常规使用静脉注射瑞芬太尼患者自控镇痛（PCA），方案为按需每两分钟给予 40μg 推注，持续脉搏血氧饱和度监测和强制性一对一护理。我们检查了瑞芬太尼的使用情况，并与我们单位提供的其他镇痛选择进行了比较，比较了分娩方式、阿普加评分、新生儿复苏和新生儿重症监护病房入院等结果。
我们回顾性地确定了 2005 年至 2014 年期间在我们单位分娩并在分娩期间接受瑞芬太尼、吗啡或硬膜外镇痛的妇女。数据来自北爱尔兰产妇系统电子数据库，该数据库记录了北爱尔兰所有产科单位的分娩细节。从我们单位接受瑞芬太尼的所有妇女的助产士分娩后填写的纸质调查问卷中获得了额外的数据。将接受瑞芬太尼、吗啡或硬膜外技术分娩镇痛的妇女的结果进行了比较。
在 10 年期间，瑞芬太尼是最受欢迎的镇痛形式，有 31.9%（8170/25617）的妇女选择了瑞芬太尼。与选择吗啡或硬膜外镇痛的妇女相比，使用瑞芬太尼的妇女器械分娩和剖宫产的比例相似。新生儿阿普加评分也相似。选择瑞芬太尼 PCA 的妇女新生儿复苏或新生儿病房入院的可能性也没有增加。
在我们单位使用的指南下，使用瑞芬太尼 PCA 超过 10 年，我们发现瑞芬太尼 PCA 既不比其他镇痛选择更不安全，也与不良结果无关。
