Självadministrerat remifentanil vid förlossning. Nöjda mammor trots måttlig smärtlindring, visar kvalitetssäkringsprojekt
Sammanfattning
Intravenous patient controlled analgesia (PCA) with remifentanil during labor is increasingly being used in many countries despite many unresolved issues regarding efficacy, dosing, staffing requirements and overall safety. We present our first experience with PCA remifentanil during labor. Twenty-one women with contraindications to epidural analgesia (EDA) were treated. One case was excluded due to equipment failure. The majority were induced labors (16/20) in primiparas (13/20). Eighteen of 20 women rated the treatment as good or very good, despite a very modest reduction in pain scores. There were no major maternal or neonatal side effects. All women were delivered vaginally, in one case assisted by vacuum extraction. The high maternal satisfaction is likely due to a combination of several effects: motivated women because of a contraindication to EDA, moderate pain relief, reduction of affective symptoms, experience of »control«, and one-to-one midwife care.