Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
PLoS One. 2022 Dec 19;17(12):e0275716. doi: 10.1371/journal.pone.0275716. eCollection 2022.
Remifentanil patient-controlled analgesia (rPCA) and epidural analgesia (EA) has been used for pain relief in labor. We aimed to evaluate the efficacy and safety of rPCA versus EA in labor, to provide evidence support for clinical analgesia and pain care.
We searched PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu databases for RCTs comparing rPCA and EA in labor until February 15, 2022. Two researchers independently screened literature and extracted data. RevMan 5.3 software was used for data analysis.
A total of 10 RCTs involving 3086 parturients were enrolled, 1549 parturients received rPCA and 1537 received EA. Meta-analysis indicated that the incidence of intrapartum maternal fever within 1 hour of labor analgesia (OR = 0.43, 95%CI: 0.300.62), after 1 hour of labor analgesia (OR = 0.42, 95%CI: 0.200.90) in the rPCA was significantly less than that of EA (all P<0.05). The incidence of respiratory depression (OR = 3.56, 95%CI: 2.455.16, P<0.001) in the rPCA was significantly higher than that of EA. There were no significant differences in the incidence of Apgar scores<7 at 5 minutes (OR = 1.18, 95%CI: 0.711.96, P = 0.53), the patients' satisfaction of pain relief during labor analgesia (SMD = 0.03, 95%CI: -0.40~0.46, P = 0.90) between rPCA and EA (all P>0.05).
rPCA can be an optional alternative to EA with similar pain relief and less risk of intrapartum maternal fever. However, rPCA was associated with increased risk of respiratory depression. Future studies with rigorous design and larger sample size are needed to provide more reliable evidences for clinical rPCA and EA use.
瑞芬太尼患者自控镇痛（rPCA）和硬膜外镇痛（EA）已被用于分娩镇痛。我们旨在评估 rPCA 与 EA 在分娩中的疗效和安全性，为临床镇痛和疼痛护理提供证据支持。
我们检索了 PubMed、EMBASE、ScienceDirect、Cochrane 图书馆、中国知网（CNKI）、万方和维普数据库，以获取比较 rPCA 与 EA 在分娩中的 RCT 研究，检索截至 2022 年 2 月 15 日。两位研究者独立筛选文献并提取数据。采用 RevMan 5.3 软件进行数据分析。
共纳入 10 项 RCT 研究，共 3086 名产妇，1549 名产妇接受 rPCA，1537 名产妇接受 EA。Meta 分析表明，rPCA 组在分娩镇痛后 1 小时内（OR = 0.43，95%CI：0.300.62）和 1 小时后（OR = 0.42，95%CI：0.200.90）产妇产时发热的发生率明显低于 EA 组（均 P<0.05）。rPCA 组呼吸抑制的发生率（OR = 3.56，95%CI：2.455.16，P<0.001）明显高于 EA 组。rPCA 组与 EA 组在 5 分钟时 Apgar 评分<7 的发生率（OR = 1.18，95%CI：0.711.96，P = 0.53）、产妇对分娩镇痛期间疼痛缓解的满意度（SMD = 0.03，95%CI：-0.40~0.46，P = 0.90）方面差异均无统计学意义（均 P>0.05）。
rPCA 可以作为 EA 的一种替代选择，具有相似的镇痛效果和较低的产时发热风险。然而，rPCA 与呼吸抑制的风险增加有关。需要设计更严格、样本量更大的未来研究，为临床 rPCA 和 EA 的应用提供更可靠的证据。
