Comparison of bolus and continuous remifentanil infusions at patient controlled analgesia for labour analgesia

Aim: To compare the analgesic efficacy and side effects of two different protocols of patient controlled remifentanil application (bolus and bolus + infusion) with intramusculer meperidine (1 mgr/kg) used to avoid the labor pain during the birth.Material and method: Cukurova University Faculty of Medicine Ethics Committee consent, 90 pregnant women scheduled for vaginal birth, were divided into 3 main groups. 1 mg/kg i.m. meperidine was given to group M which consists 15 primiparous and 15 multiparous cases. 0.25 micrograms/kg i.v. remifentanil bolus dose was given, with the help of a PCA device, to group B consisting of 15 primiparous and 15 multiparous patients. 0.25 micrograms/kg i.v. remifentanil bolus dose and 0.025 micrograms/kg/dk i.v. remifentanil infusion was given, with the help of a PCA device, to group B consisting of 15 primiparous and 15 multiparous patients. PCA was terminated after the birth of the newborn. The systolic-diastolic arterial pressure, maternal heart rate, pain VRS, patient comfort and sedation scores were evaluated during the labor. 1. and 5. min. APGAR scores were recorded following the birth.Results: There were a statistically significant drop in the mean pain VRS scores during labor and at birth according to the initial pain VRS scores (p<0.05). The mean pain VRS scores during labor in Group B and Group I were found lower than group M (p<0.05). During the labor, average pain VRS scores in Group I were lower than Group B (p<0.05). Average pain VRS scores were similar in Group I and Group B at birth (p>0.05). Mean sedation scores were similar during labor and at birth in all groups (p>0.05). The mean patient comfort scores during labor in Group B and Group I were found lower than group M (p<0.05). During the labor, average patient comfort scores in Group I were lower than Group B (p<0.05). Average patient comfort scores were similar in Group I and Group B at birth (p>0.05). There were no cases of hypotension and bradycardia. None of the cases did not fall below 96% oxygen saturation values. In all groups, 1 and 5 min. APGAR scores were within normal limits.Conclusion: It was considered to be preferable i.v. patient controlled remifentanil for labor analgesia instead of i.m. meperidine because of it's more efficient and comfortable without causing more side effects than meperidine.Key words: Painless birth, remifentanil, patient-controlled analgesia