Evaluation Of The Efficacy And Safety Of Patient-controlled Intravenous Analgesia (PCIA) With Remifentanil During Labor

Objective:This paper evaluates the efficacy and safety of patient-controlled analgesia(PCA)with remifentanil during labor.Methods:From February 2017 to March 2018,a total of 201 cases of parturients who delivered in Second Affiliated Hospital of Nanjing Medical University and Nanjing Medical University Sir Run Run Hospital were enrolled as subjects.According to the analgesic techniques,the 201 parturients were divided into the PCIA Group(n=110)which received remifentanil patient—controlled intravenous analgesia,the Epidural Anesthesia Group(n=35)which received patient—controlled epidural analgesia with sufentanil combined ropivacaine,and the Control Group(n=56)which received no analgesia during labor.The primary parameters include the scale of the Chinese version of the Short Form—McGill Pain Questionnaire(SF—MPQ),effect of analgesia(including nausea,vomiting and dizziness),the vital signs during labor(which concludes the blood pressure,pulse rate,respiratory rate and oxyhemoglobin saturation),mode of delivery,cesarean section rate,postpartum blood loss and the satisfaction from parturients of their labor analgesia both in Epidural Anesthesia Group and PCIA Group.The secondary parameters include the newborns'one-minute and five-minute Apgar Score,and the DST result(which includes DQ and MI scores)when the newborns turned three months old.Results:In comparison to the Control Group,there was a significant decrease of pain scores both in the PCIA Group and the Epidural Anesthesia Group(P<0.05)but with higher pain scores in the PCIA Group.After the administration of the medication,subjects in both the PCIA Group and the Epidural Anesthesia group experienced lowering in blood pressure,and the difference was statistically significant(P<0.05).But Epidural analgesia could extend the duration of the second stage of the labor(57.33±2.85min).Compared with the PCIA Group(46.87±1.61min)and the control group(49.20±1.71min),The second stage duration in the Epidural Anesthesia Group is statistically significantly longer(F=5.589,P=0.004<0.05).Both of two groups(Epidural Anesthesia Group and PCIA Group)obtained high degree of satisfaction from parturients of their labor analgesia(?~2=0.054,P=0.815>0.05),The incidence of adverse effects in Epidural Anesthesia group is higher than that in the other two groups,and the difference was statistically different(P<0.05).There was no significant difference in the cesarean section rate,the mode of delivery,the postpartum blood loss,and the vital signs(of both the parturients and the newborns)among all three groups.There was no significant in the 1min Apgar score of the newborns(F=1.157,P=0.316>0.05),5min Apgar score of newborns(F=0.506,P=0.603>0.05)and oxyhemoglobin saturation(F=0.460,P>0.05)among all three groups.In addition,there was no significant difference in the newborns'the DST result which includes MI and DQ score among all three groups.Conclusion:Compared to epidural anesthesia,which has more advanced analgesic effect,the patient-controlled intravenous analgesia with remifentanil,as a new analgesic technique,is still an effective and safe procedure which significantly relieves pain,has less impact on the duration of the second stage of labor,has less side effects on the parturients,and is simple to operate.