A comparison of remifentanil patient-controlled analgesia with epidural analgesia during labor.

Purpose of this study is to compare the analgesic efficacy and safety of remifentanil, administered as patient-controlled analgesia, with epidural analgesia.




Objective:

1. Quality of pain relief as determined by Visual Analogue Scale scores;

2. Patient satisfaction;

3. Fetal outcome as determined by Apgar scores, umbilical cord pH, NACS and requirement for naloxone.




Methods: 20 patients. One group will receive remifentanil patient controlled analgesia (bolus 40 microgram. lockout 2 min). The other group will receive epidural analgesia (ropivacaine/sufentanil). Analgesia will be admininsterd throughout the first stage of labor.
Baseline non-invasive measurements will be made at regular intervals. Pain and satisfaction scores will be assessed using a visual analogue scale (VAS). Fetal heart rate will be measured and scored as reactive or non reactive. Observations for known side effects will be made. At delivery Apgarscore, bloodgas analysis and NACS will be recorded.

The hypothesis is that epidural analgesia will provide better painrelief during labor with less side-effects than remifentanil.

N/A

1. 10 patients will receive remifentanil patient controlled analgesia;

2. 10 patients will receive epidural analgesia;

Medication will be started in active labor and will be continued untill full dilation of the cervix is achieved.