Effect and Safety of Remifentanil Patient-Controlled Analgesia Compared with Epidural Analgesia in Labor: An Updated Meta-Analysis of Randomized Controlled Trials

2021 ◽  
pp. 1-8
Author(s):  
Peijun Zhang ◽  
Zhiqiang Yu ◽  
Meili Zhai ◽  
Jian Cui ◽  
Jianbo Wang
Keyword(s):  
Pain Relief ◽  
Epidural Analgesia ◽  
Mean Difference ◽  
Oxygen Desaturation ◽  
Cochrane Library ◽  
Patient Controlled Analgesia ◽  
Apgar Scores ◽  
Pain Scores ◽  
Significant Difference ◽  
Spontaneous Delivery

<b><i>Purpose:</i></b> The study was aimed to systematically assess the effect and safety of remifentanil patient-controlled analgesia (rPCA) versus epidural analgesia (EA) during labor. <b><i>Methods:</i></b> Eligible trials were retrieved from PubMed, EMBASE, ScienceDirect, and Cochrane Library before April 2020. The primary outcomes were patient satisfaction with pain relief and average visual analog scale (VAS) pain scores during labor; the secondary outcomes were rate of spontaneous delivery, oxygen desaturation, maternal hyperthermia, and neonatal Apgar scores &#x3c;7 at 1 and 5 min. <b><i>Results:</i></b> Eleven studies involving 3,039 parturients were included. We found that parturients receiving rPCA were similarly satisfied with pain relief compared to those receiving EA (standardized mean difference: −0.19; 95% confidence interval [CI]: −0.57, 0.18), though had significantly higher VAS pain scores during labor (weighted mean difference: 1.41; 95% CI: 0.32, 2.50). The rate of spontaneous delivery was comparable. rPCA increased the risk of maternal oxygen desaturation (risk ratio [RR]:3.23, 95% CI: 1.98, 5.30). There was no statistical significance regarding hyperthermia (RR: 0.49, 95% CI: 0.24, 1.01). No significant difference was found for neonatal Apgar scores &#x3c;7 at 1 and 5 min. <b><i>Conclusion:</i></b> rPCA could be an optional alternative for pain relief to EA without worsening maternal satisfaction with pain relief, delivery modes, or neonatal morbidity. However, rPCA was associated with higher pain intensity during labor and higher incidence of maternal oxygen desaturation. The routine use of rPCA in labor must be armed with close respiratory monitoring. Continued well-designed studies are required to provide more robust evidence.

Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia

2017 ◽  
Vol 71 (2) ◽  
pp. 99-104
Author(s):  
Dafina Karadjova ◽  
Mirjana Shosholcheva ◽  
Atanas Sivevski ◽  
Emilija Ivanov ◽  
Ivo Kjaev ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Epidural Analgesia ◽  
Labor Analgesia ◽  
Nausea And Vomiting ◽  
Pain Patient ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Pain ◽  
Remifentanil Group

Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.

scholarly journals Comparison of efficacy and safety of oxycodone versus fentanyl for intravenous patient-controlled analgesia in postoperative pain management: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Peng Chen ◽  
Fuchao Chen ◽  
Jiexin Lei ◽  
zhou benhong
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Meta Analysis ◽  
Postoperative Pain Relief ◽  
Cochrane Library ◽  
Patient Controlled Analgesia ◽  
Significant Difference

Abstract Backgroud Patient-controlled analgesia(PCA) with intravenous an opioid has been suggested as a effective method of postoperative pain relief. There are several randomized controlled trials (RCTs) of comparison of oxycodone and fentanyl for IV-PCA in surgical patients. The purpose of this study was to performed a meta-analysis to compare the effect of intravenous oxycodone and fentanyl on post-operative pain in sugical patients from collected current data. Methods The RCTs of oxycodone versus fentanyl for IV-PCA were gathered from PubMed, Embase, Cochrane library, CNKI and VIP data. After data extraction and quality assessment of the included RCTs, the RevMan 5.3 software was applied for meta-analysis of numerical rating scale (NRS) scores, accumulated IV-PCA consumption of oxycodone and fentanyl, patient satisfaction, postoperative nausea and vomiting (PONV), and other adverse events (AEs). Results Results reported from eight RCTs involving 600 patients are included in the meta-analysis. The NRS score at rest and upon movement of group oxycodone was significantly lower than that of group fentanyl (WMD= -3.85, 95% CI -4.93~-2.76, P<0.00001; WMD= -4.31, 95% CI -5.79~-2.84, P<0.00001); however, the incidence of PONV and dizziness was significantly higher in group oxycodone than in group fentanyl (OR = 2.41, 95% CI 1.60~3.63, P < 0.0001; OR=3.69, 95% CI 2.17~6.26, P<0.00001). Accumulated IV-PCA consumption in group oxycodone was less than in group fentanyl overall the 48 hours postoperatively (WMD= -12.11, 95% CI -18.42~-5.80, P = 0.0002). There was no significant difference in patient satisfaction between oxycodone and fentanyl (OR=0.73, 95% CI 0.11~5.04, P= 0.75). Conclusion According to the evidence, this meta-analysis suggest that oxycodone IV-PCA is superior to fentanyl in postoperative pain relief, whereas the higher incidence of PONV and dizziness was accompanied with oxycodone. Further large-scale and well-designed studies are needed to summarize and analyse the data to draw a more convincing conclusion.

Paravertebral Block versus Thoracic Epidural Analgesia for Postthoracotomy Pain Relief: A Meta-Analysis of Randomized Trials

2021 ◽  
Author(s):  
Mu Xu ◽  
Jiajia Hu ◽  
Jianqin Yan ◽  
Hong Yan ◽  
Chengliang Zhang
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Meta Analysis ◽  
Thoracic Epidural Analgesia ◽  
Paravertebral Block ◽  
Cochrane Library ◽  
Thoracic Epidural ◽  
Analgesic Consumption ◽  
Postthoracotomy Pain

Abstract Objective Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used for postthoracotomy pain management. The purpose of this research is to evaluate the effects of TEA versus PVB for postthoracotomy pain relief. Methods A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library (last performed on August 2020) to identify randomized controlled trials comparing PVB and TEA for thoracotomy. The rest and dynamic visual analog scale (VAS) scores, rescue analgesic consumption, the incidences of side effects were pooled. Results Sixteen trials involving 1,000 patients were included in this meta-analysis. The pooled results showed that the rest and dynamic VAS at 12, 24, and rest VAS at 48 hours were similar between PVB and TEA groups. The rescue analgesic consumption (weighted mean differences: 3.81; 95% confidence interval [CI]: 0.982–6.638, p < 0.01) and the incidence of rescue analgesia (relative risk [RR]: 1.963; 95% CI: 1.336–2.884, p < 0.01) were less in TEA group. However, the incidence of hypotension (RR: 0.228; 95% CI: 0.137–0.380, p < 0.001), urinary retention (RR: 0.392; 95% CI: 0.198–0.776, p < 0.01), and vomiting (RR: 0.665; 95% CI: 0.451–0.981, p < 0.05) was less in PVB group. Conclusion For thoracotomy, PVB may provide no superior analgesia compared with TEA but PVB can reduce side effects. Thus, individualized treatment is recommended. Further study is still necessary to determine which concentration of local anesthetics can be used for PVB and can provide equal analgesic efficiency to TEA.

scholarly journals Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (12) ◽  
pp. 2636
Author(s):  
Ka Wing Ma ◽  
Hoonsub So ◽  
Euisoo Shin ◽  
Janice Hoi Man Mok ◽  
Kim Ho Kam Yuen ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Meta Analysis ◽  
Small Sample ◽  
Cochrane Library ◽  
Endoscopic Drainage ◽  
Complication Rates ◽  
Surgical Drainage ◽  
Endocrine Insufficiency ◽  
Significant Difference

There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.

scholarly journals Pharmacological and Non-Pharmacological Methods of Labour Pain Relief—Establishment of Effectiveness and Comparison

2018 ◽  
Vol 15 (12) ◽  
pp. 2792 ◽  
Author(s):  
Iwona Czech ◽  
Piotr Fuchs ◽  
Anna Fuchs ◽  
Miłosz Lorek ◽  
Dominika Tobolska-Lorek ◽  
...  
Keyword(s):  
Pain Relief ◽  
Epidural Analgesia ◽  
Water Immersion ◽  
Labour Pain ◽  
Satisfaction Level ◽  
Pain Level ◽  
Mean Values ◽  
Significant Difference ◽  
Third Stage ◽  
Water Birth

Background: To evaluate the effectiveness of pharmacological and non-pharmacological pain relief methods and to compare them. Materials and methods: 258 women were included in the study and interviewed using a questionnaire and the visual analogue scale for pain. They were divided into six groups depending on chosen method of labour pain relief: epidural anaesthesia (EA; n = 42), water immersion and water birth (WB; n = 40), nitrous oxide gas for pain control (G; n = 40), transcutaneous electrical nerve stimulation (TENS) (n = 50), multiple management (MM; n = 42), none (N; n = 44). Results: The average age of the women was 29.4 ± 3.74 years and 60.47% of them were nulliparous (n = 156). Mean values of labour pain intensity were 6.81 ± 2.26 during the first stage of labour; 7.86 ± 2.06 during the second stage, and 3.22 ± 2.46 during the third stage. There was no significant difference in pain level between epidural analgesia and gas groups in the first stage of labour (p = 0.74). Nevertheless, epidural analgesia reduced pain level during the second and third stage (both p < 0.01). The highest satisfaction level pertains to water immersion (n = 38; 95%). Conclusion: Epidural analgesia is the gold standard of labour pain relief, however water birth was found to be associated with the highest satisfaction level of the parturient women. The contentment of childbirth depends not only on the level of experienced pain, but also on the care provided to the parturient during pregnancy and labour.

scholarly journals Assessment of the effect of vacuum-formed retainers and Hawley retainers on periodontal health: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253968
Author(s):  
Bowen Li ◽  
Yifeng Xu ◽  
Cailian Lu ◽  
Zhenheng Wei ◽  
Yongyue Li ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Grey Literature ◽  
Mean Difference ◽  
Cochrane Library ◽  
Periodontal Health ◽  
Probing Depth ◽  
Significant Difference ◽  
Orthodontic Patients ◽  
The Cochrane Library ◽  
Sulcus Probing Depth

Background Recently, increasing attention has been paid to the periodontal health of orthodontic patients in the maintenance stage in clinical practice. The focus of this meta-analysis was to compare the effects of vacuum-formed retainers (VFR) and Hawley retainers (HR) on periodontal health, in order to provide a reference for clinical selection. Methods From the establishment of the database until November 2020, a large number of databases were searched to find relevant randomized control trials, including the Cochrane Library databases, Embase, PubMed, Medline via Ovi, Web of Science, Scopus, Grey Literature in Europe, Google Scholar and CNKI. Related literature was manually searched and included in the analysis. Two researchers screened the literature according to relevant criteria. The size of the effect was determined using RevMan5.3 software, and the mean difference and 95% confidence intervals (CI) were used to estimate the results using a random effects model. Results This meta-analysis included six randomized controlled trials involving 304 patients. The results of the meta-analysis showed that there was no statistical difference in sulcus probing depth status between the VFR group and the HR group, including at 1, 3, and 6 months. Compared with the VFR group, the HR group showed a lower gingival index at 1 month (mean difference = 0.12, 95%CI: 0.06 to 0.19) and 3 months (mean difference = 0.11, 95%CI: 0.06 to 0.17), while there was no statistically significant difference at 6 months (mean difference = 0.10, 95%CI: -0.07 to 0.27). The plaque index of the HR group also showed a good state at 1 month (mean difference = 0.06, 95%CI: 0.01 to 0.12), 3 months (mean difference = 0.12, 95%CI: 0.08 to 0.16), and 6 months (mean difference = 0.19, 95%CI: 0.09 to 0.29). Subgroup analysis of PLI showed that when all teeth were measured, PLI status was lower in the HR group at 6 months (mean difference = 0.32, 95%CI: 0.18 to 0.46). PLI status was also low for the other teeth group (mean difference = 0.15, 95%CI: 0.08 to 0.22). Conclusion Our meta-analysis showed that patients using the Hawley retainer had better periodontal health compared with those using vacuum-formed retainers. However, more research is needed to look at the periodontal health of patients using these two retainers.

scholarly journals Inflammatory and oxidative alterations of water immersion and epidural analgesia during the labor

2020 ◽  
Vol 7 (8) ◽  
pp. 598-602
Author(s):  
Ümit Yasemin Sert ◽  
Özlem Uzunlar ◽  
Nezaket Kadıoğlu ◽  
Tuba Candar ◽  
Yaprak Engin Üstün
Keyword(s):  
Epidural Analgesia ◽  
Water Immersion ◽  
Demographic Data ◽  
Total Serum ◽  
Control Group ◽  
Epidural Group ◽  
Birth Process ◽  
Apgar Scores ◽  
Significant Difference ◽  
And Control

Objective: Water immersion and epidural analgesia are both pain relief methods used to perceive less pain during the labor process. There are concerns about the maternal and fetal outcomes, although studies presented no significant complication directly related to these methods. We aimed to compare the IL-1 and 6 levels, Total serum oxidant (TOS), antioxidant (TAS) and catalase levels of births with epidural analgesia, water immersion and conventional birth without analgesia. Material and Methods: A total of 88 patients were included in the study (The water immersion group included 29 patients, while the epidural analgesia and control group included 30 and 29 patients respectively). Umblical cord IL-1, IL-6, catalase, TAS, TOS levels, neonatal Apgar scores, duration of birth process and demographic data were compared between three groups Results: There was no significant difference between the three groups in terms of age, Body mass index (BMI), gravidity, parity, gestational week, and birth weight (p>0.05). TOS and IL-6 levels were significantly lower in epidural group than others (p=0.031, p=0.019 respectively). Apgar scores were significantly lower in epidural group (p<0.001). Conclusion: The water immersion and epidural analgesia were found to have no adverse effect on oxidative status and infection parameters of women.

scholarly journals Patient-Controlled Epidural Analgesia in Labour — is a Continuous Infusion of Benefit?

1992 ◽  
Vol 20 (1) ◽  
pp. 15-20 ◽  
Author(s):  
M. J. Paech
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Patient Controlled Analgesia ◽  
Self Administration ◽  
High Quality ◽  
Active Labour ◽  
Background Infusion ◽  
Significant Difference ◽  
Continuous Background ◽  
Single Blind

A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia — bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. Up to three additional staff-administered supplements of 0.5% bupivacaine 4 ml (20 mg) were allowed. There was no significant difference between groups with respect to pain relief, supplementary boluses required, satisfaction, side-effects or details of patient-controlled epidural analgesia, with the exception of greater fentanyl usage in the bolus plus infusion group (P < 0.003). Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.

Serotonin–norepinephrine reuptake inhibitors for the prevention of migraine and vestibular migraine: a systematic review and meta-analysis

2020 ◽  
Vol 45 (5) ◽  
pp. 323-330 ◽  
Author(s):  
Fengzhi Wang ◽  
Jiaoqi Wang ◽  
Yumeng Cao ◽  
Zhongxin Xu
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Vestibular Migraine ◽  
Cochrane Library ◽  
Severity Scores ◽  
Significant Difference ◽  
Norepinephrine Reuptake ◽  
Better Than

Background and objectivesThe role of serotonin–norepinephrine reuptake inhibitors (SNRIs) in migraine prophylaxis has not been completely established. Current treatments for vestibular migraine (VM) are based on scarce evidence. We aimed to perform an updated review focusing on the efficacy and tolerability of SNRIs for migraine and VM prevention.MethodsWe searched the PubMed, Web of Science, and Cochrane Library databases for relevant studies. The primary outcome was migraine frequency. In the case of VM, the Dizziness Handicap Inventory (DHI) scores and Vertigo Severity Scores (VSSs) were extracted.ResultsSix randomized controlled trials involving 418 patients were analyzed. Patients receiving SNRIs had fewer migraine days than those receiving a placebo (standardized mean difference −0.38, 95% CI −0.76 to −0.01, p=0.04). The effects of SNRIs and other active drugs were comparable. In patients with VM, venlafaxine had a significant advantage over other active drugs in decreasing the VSS (weighted mean difference (MD) −1.45, 95% CI −2.11 to −0.78, p<0.0001) and the emotional domain score of the DHI (MD −2.64, 95% CI −4.97 to −0.31, p=0.03). We found no significant difference in the rate of withdrawals due to any reason or withdrawals due to side effects between SNRIs and active drugs and between SNRIs and a placebo.ConclusionsSNRIs were clinically safe and effective for migraine and VM prophylaxis, were better than a placebo, and not inferior to other active drugs. SNRIs may be a preferable choice for patients with VM with psychiatric disorders.

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