Patient-controlled remifentanil analgesia during oocyte retrieval for IVF/ICSI procedures.

Oocyte retrieval for in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI) as infertility treatments is commonly obtained by ultrasound-guided, transvaginal puncture of the ovaries, which is unpleasant and painful for the patient. Although most patients tolerate the procedure well, oocyte retrieval may even be associated with severe visceral pain in a small percentage of patients, especially in patients suffering from endometriosis. In the VU University Medical Center, oocyte retrieval is currently performed under intramuscular pethidine analgesia in combination with light, conscious sedation using an oral short-acting benzodiazepine midazolam (Dormicum® 7,5mg). However, the analgesic efficacy of pethidine has only been scarcely investigated and the single-dose regime for pethidine is not always sufficient to provide optimal pain relief during oocyte retrieval. Remifentanil is a synthetic opioid with an ultra-short half-life characterized by a rapid onset of action and short latency to its peak effect and may be used for patient controlled analgesia. Currently there are no studies available evaluating the use of remifentanil in patient-controlled analgesia during oocyte retrieval. Furthermore, this analgesic technique has only been scarcely evaluated in comparison with intravenous administration of pethidine. The current study therefore aims to compare the analgesic efficacy and safety of remifentanil versus pethidine in the relief of puncture pain during oocyte retrieval.

Is patient-controlled analgesia with remifentanil more efficacious and equally safe as pethidine as analgesic strategy during ultrasound guided transvaginal oocyte retrieval.

N/A

Standard therapy will consist of routine conscious sedation with midazolam (7.5 mg per os) and pethidine (2 mg/kg bodyweight i.m.). Both medications will be administered 30 minutes before the puncture procedure. Since the half-life of pethidine is 3-5 hours, post-puncture analgesia will start when patients are at home.



The investigational treatment consists of continuous intravenous remifentanil administration of 0.05 microgram/kg/minute with the possibility of self-administration of a remifentanil bolus with a dosage of 0.5 microgram/kg per bolus and a lock out of 2 minutes. Remifentanil infusion will start 5 minutes before oocyte retrieval. Since remifentanil has a very short half-life, the analgesic effect of remifentanil will disappear within 5 minutes after the end of remifentanil infusion. The remifentanil infusion will therefore be preceded by preemptive administration of diclofenac (50 mg sup.) for treatment of post-puncture pain 60 minutes before the start of oocyte retrieval.