Differences in maternal temperature and saturation after administration of remifentanil PCA or epidural analgesia during labor

Epidural analgesia is considered to be the best form of pain relief during
labor. However its use has been associated with an increase of maternal
temperature. This can lead to unnecessary administration of antibiotics during
labor and observation and treatment for sepsis of neonates.
A relatively new option for obstetric analgesia is remifentanil PCA. Possible
adverse effects of remifentanil resemble those of other opioids and include
hypotension and respiratory depression.

Hypothesis:
1. Epidural analgesia leads to a higher frequency of maternal fever as compared
to patients receiving remifentanil PCA or no analgesia.
2. Maternal saturation scores are lower in parturients receiving remifentanil
PCA compared to patients receiving epidural analgesia or no analgesia.

The main objective of this study is to compare changes in maternal temperature
and oxygen saturation in patients receiving remifentanil, administered
intravenous patient-controlled, with those of epidural analgesia.

This study will be a prospective randomized controlled trial and will evaluate
differences in maternal saturation and temperature in parturients receiving
either remifentanil PCA or epidural analgesia.

Remifentanil group: 40microgram boluses, lockout time 2 min. Maximum dose
limit is 1200 microgram/hour.

Epidural group: ropivacaine plus sufentanil.
Loading dose 25 mg (12.5 ml ropivacaine 0.2%), followed by continuous infusion
of ropivacaine 0.1%/sufentanil 0.5 microgram/ml.
Infusion rate 10 ml/hour.
In case of inadequate analgesia, additional boluses of the epidural solution
will be given.

Pulse and saturation will be monitored continuously by means of a Nonin WristOx
pulsoximeter.
Maternal bloodpressure, temperature and respiratory rate will be recorded
hourly.
In patients receiving epidural analgesia or remifentanil PCA, measurements of
bloodpressure and respiratory rate will be recorded every 5 minutes for the
fist 30 minutes, and every hour afterwards.

Painscores will be assessed using a visual analogue scale every hour. After
delivery patients will be asked to give an overall satisfaction score

Fetal heart rate and uterine activity will be monitored continuously by
external monitoring and if necessary by invasive monitoring.

In patients receiving epidural analgesia, motor block of the lower limbs will
be assessed.

Adverse effects of analgesics used in this study include hypotension, nausea
and rarely respiratory depression. For savety reasons, there will be a observer
in the delivery suite all times providing continuous monitoring.