Epidural Analgesia versus Remifentanil Patient Controlled Analgesia in Labor: A Survey of Practice in the Netherlands - Abstract
Introduction: Epidural analgesia is widely recommended as method of choice for pain relief during labor whereas it is recommended to use remifentanil patient controlled analgesia only in the context of a randomized clinical trial.
The aim of the study was to investigate the availability and use of epidural analgesia and remifentanil patient controlled analgesia, in all Dutch hospitals.
Material and Methods: We extracted data on the use of epidural analgesia as pain relief for women in labor from the Netherlands Perinatal Registry. Because data on remifentanil patient controlled analgesia are not available in the registry, we also sent an anonymous online survey via email to all 90 hospitals with an obstetric ward in the Netherlands. The survey contained questions about obstetric analgesia with a focus
on the availability and use of epidural analgesia and remifentanil patient controlled analgesia.
Results: In 2010 15% of 176,810 women giving birth in the Netherlands received epidural analgesia while 11.6 % received opioids. Response rate to the survey was 67% (60). Remifentanil patient controlled analgesia was available in 47% (28). In 67% of those hospitals remifentanil patient controlled analgesia was available for all
laboring women whereas 14% only offered it to women with a contra-indication for epidural analgesia. Most hospitals use a flexible background infusion and a bolus dose of 30 µgram. When only epidural analgesia was available 20% of women used pain relief (range 8-43%), versus 38% when epidural analgesia and remifentanil patient controlled analgesia were available (range 26-63%) (p<0. 001).
Conclusion: Offering epidural analgesia and remifentanil patient controlled analgesia increases the use of analgesia over offering epidural analgesia alone. Despite the recommendation to use RPCA only in an experimental setting, remifentanil patient controlled analgesia is offered in almost 50% of hospitals.