Epidural analgesia versus Remifentanil PCA during labour

In the Netherlands analgesia during labor consists of Pethidin im or epidural
analgesia. Both methods have their side effects. Pethidin has a half life of
3-4 hours and can be quite sedative and can cause impaired thinking with
hallucinations. Especially the respiratoiry depression may be a threat to the
infant. With the introduction of the Remifentanil PCA on our OBGY ward we, as
in the current literature, experience less opiod side effects as seen with
Pethidin. Remifentanil has a half life of only a few minutes. Therefore, we
hypothise that remifentanil is an attractive replacer of Pethidin, and in
addition, a competitive treatment of epidural analgesia. Introducing epidural
analgesia on the ward often causes a delay since an anesthesiologist is
required. Moreover, patients are restricted to bed, somethimes describe the
feeling of not being part of the labor process and increased risk for vacuum or
forceps delivery and unexplained fever.

To compare Remifentanil PCA with epidural anesthesia among healthy
nulligravidia during labor.

Two groups of healthy nulligravida, the study group with Remifentanil PCA, and
the control group with epidural anesthesia are compared.

The study group receives a Remifantanil PCA, which will be connected to the IV
line. The control group receives a standard epidural procedure for catheter
placement.

Both methods of analgesia are applied methods of analgesia during labor. There
are no expected increased risks associated.