Cochrane · systematic review · CD011989
Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour
Weibel, S, Jelting, Y, Afshari, A, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
25
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 10 · 28.6%Very low 12 · 34.3%Low 10 · 28.6%Moderate 3 · 8.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Remifentanil (PCA) compared to another opioid (IV/IM) for pain management in labour
Population: women in labour with planned vaginal delivery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Satisfaction (overall) with pain relief (VAS 0 to 10 cm, NRS 1 to 4, NRS 0 to 10, VRS 0 to 5) Remifentanil (PCA) vs another opioid (IV/IM) | no estimate extracted | 4 studies · 216 participants | Very low Downgraded: risk of bias |
Pain intensity 'early' (30 min/1 h) (VAS 0 to 10 cm, VAS 0 to 100 cm) Remifentanil (PCA) vs another opioid (IV/IM) | no estimate extracted | 3 studies · 180 participants | Very low Downgraded: risk of bias |
Additional analgesia required (escape analgesia) Remifentanil (PCA) vs another opioid (IV/IM) | RR 0.57 [0.4, 0.81] | 3 studies · 190 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Rate of caesarean delivery Remifentanil (PCA) vs another opioid (IV/IM) | RR 0.63 [0.3, 1.32] | 4 studies · 215 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal apnoea Remifentanil (PCA) vs another opioid (IV/IM) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Maternal respiratory depression (< 8 breaths/min) Remifentanil (PCA) vs another opioid (IV/IM) | no estimate extracted | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Apgar score < 7 at 5 min Remifentanil (PCA) vs another opioid (IV/IM) | no estimate extracted | 1 study · 88 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Remifentanil (PCA) compared to another opioid (PCA) for pain management in labour
Population: women in labour with planned vaginal delivery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Satisfaction (overall) with pain relief (VRS 1 to 10) Remifentanil (PCA) vs another opioid (PCA) | no estimate extracted | 1 study · 110 participants | Very low Downgraded: risk of bias |
Pain intensity 'early' (30 min/1 h) (VAS 0 to 10 cm, VAS 0 to 100 cm) Remifentanil (PCA) vs another opioid (PCA) | no estimate extracted | 3 studies · 215 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Additional analgesia required (escape analgesia) Remifentanil (PCA) vs another opioid (PCA) | RR 0.76 [0.45, 1.28] | 3 studies · 215 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Rate of caesarean delivery Remifentanil (PCA) vs another opioid (PCA) | RR 2.78 [0.99, 7.82] | 2 studies · 143 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal apnoea Remifentanil (PCA) vs another opioid (PCA) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Maternal respiratory depression Remifentanil (PCA) vs another opioid (PCA) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Apgar score ≤ 7 (< 7) at 5 min Remifentanil (PCA) vs another opioid (PCA) | no estimate extracted | 1 study · 17 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Remifentanil (PCA) compared to epidural/CSE for pain management in labour
Population: women in labour with planned vaginal delivery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Satisfaction (overall) with pain relief (NRS 0 to 4, 1 to 4, 0 to 10, 1 to 10, VRS 1 to 4) Remifentanil (PCA) vs epidural/CSE | no estimate extracted | 7 studies · 2135 participants | Very low Downgraded: risk of bias |
Pain intensity 'early' (1 h) (VAS 0 to 10 cm, VAS 0 to 100 cm, NRS 0 to 10) Remifentanil (PCA) vs epidural/CSE | no estimate extracted | 6 studies · 235 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Additional analgesia required Remifentanil (PCA) vs epidural/CSE | RR 9.27 [3.73, 23.03] | 6 studies · 1037 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Rate of caesarean delivery Remifentanil (PCA) vs epidural/CSE | RR 1 [0.82, 1.22] | 9 studies · 1578 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Maternal apnoea Remifentanil (PCA) vs epidural/CSE | no estimate extracted | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Maternal respiratory depression (< 9, < 8 breaths/min) Remifentanil (PCA) vs epidural/CSE | RR 0.91 [0.51, 1.62] | 3 studies · 687 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Apgar score ≤ 7 (< 7) at 5 min Remifentanil (PCA) vs epidural/CSE | RR 1.26 [0.62, 2.57] | 5 studies · 1322 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Remifentanil (PCA) compared to remifentanil (continuous IV) for pain management in labour
Population: women in labour with planned vaginal delivery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Satisfaction (overall) with pain relief Remifentanil (PCA) vs remifentanil (continuous IV) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Pain intensity 'early' (30 min/1 h) (VAS 0 to 10 cm) Remifentanil (PCA) vs remifentanil (continuous IV) | no estimate extracted | 1 study · 53 participants | Very low Downgraded: risk of bias |
Additional analgesia required (escape analgesia) Remifentanil (PCA) vs remifentanil (continuous IV) | no estimate extracted | 1 study · 59 participants | Very low Downgraded: risk of bias |
Rate of caesarean delivery Remifentanil (PCA) vs remifentanil (continuous IV) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Maternal apnoea Remifentanil (PCA) vs remifentanil (continuous IV) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Maternal respiratory depression (< 8 breaths/min) Remifentanil (PCA) vs remifentanil (continuous IV) | RR 0.98 | 2 studies · 135 participants | Low Downgraded: risk of bias, imprecision |
Apgar score < 7 at 5 min Remifentanil (PCA) vs remifentanil (continuous IV) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Remifentanil (PCA, increasing bolus dose) compared to remifentanil (PCA, increasing infusion dose) for pain management in labour
Population: women in labour with planned vaginal delivery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Satisfaction (overall) with pain relief (VNRS 0 to 10) Remifentanil (PCA, increasing bolus dose) vs remifentanil (PCA, increasing infusion dose) | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Pain intensity 'early' (30 min/1 h) Remifentanil (PCA, increasing bolus dose) vs remifentanil (PCA, increasing infusion dose) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Additional analgesia required (escape analgesia) Remifentanil (PCA, increasing bolus dose) vs remifentanil (PCA, increasing infusion dose) | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Rate of caesarean delivery Remifentanil (PCA, increasing bolus dose) vs remifentanil (PCA, increasing infusion dose) | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Maternal apnoea Remifentanil (PCA, increasing bolus dose) vs remifentanil (PCA, increasing infusion dose) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Maternal respiratory depression (< 8 breaths/min) Remifentanil (PCA, increasing bolus dose) vs remifentanil (PCA, increasing infusion dose) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Apgar score < 7 at 5 min Remifentanil (PCA, increasing bolus dose) vs remifentanil (PCA, increasing infusion dose) | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |