Remifentanil em analgesia para o trabalho de parto

Eliane C S Soares; Michelle R Lucena; Renata C Ribeiro; Letícia L Rocha; Walkíria W Vilas Boas

doi:10.1590/S0034-70942010000300013

Review Article

Remifentanil em analgesia para o trabalho de parto

Remifentanil as analgesia for labor

Eliane C S Soares; Michelle R Lucena; Renata C Ribeiro; Letícia L Rocha; Walkíria W Vilas Boas

http://dx.doi.org/10.1590/S0034-70942010000300013 Braz J Anesthesiol, vol.60, n3, p.334-346, 2010

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Resumo

JUSTIFICATIVA E OBJETIVOS: As técnicas neuroaxiais representam atualmente os métodos mais efetivos para controle da dor durante o trabalho de parto e a analgesia peridural utilizando soluções anestésicas ultradiluídas é considerada o padrão ouro, promovendo alívio adequado da dor com mínimos efeitos colaterais. Em algumas situações, no entanto, o emprego dessas técnicas é limitado pela existência de contraindicações maternas ou obstáculos estruturais e materiais. Nestes casos, as opções alternativas ainda são precárias e escassas, oferecendo resultados pouco otimistas e de eficácia questionável. CONTEÚDO: Este artigo apresenta, com base em uma revisão da literatura, as informações disponíveis relacionadas ao emprego do remifentanil como técnica alternativa para a analgesia de parto discutindo aspectos farmacocinéticos, farmacodinâmicos, eficácia analgésica, satisfação materna e efeitos colaterais maternos e fetais. CONCLUSÕES: Os dados iniciais apontam o remifentanil como uma opção promissora a ser empregada nas situações em que a gestante não quer ou não pode receber a analgesia neuroaxial.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, ANALGESIA

Abstract

BACKGROUND AND OBJECTIVES: The neuraxial techniques currently represent the most effective methods for pain control during labor and the epidural block using ultradiluted anesthetic solutions is considered the gold standard promoting adequate pain relief with minimum side effects. In some situations however the use of these techniques is limited by the existence of maternal contraindications, or structural or material obstacles. In these cases, the alternatives are still precarious and scarce offering little optimistic results and of dubious effectiveness. CONTENT: This article presents through a literature review the available information on the use of remifentanil as an alternative technique for analgesia during labor discussing aspects of pharmacokinetics, analgesia efficacy, maternal satisfaction and maternal/fetal side effects. CONCLUSIONS: The initial data show that remifentanil is a promising option to be employed in situations where the parturient cannot or does not want to receive the neuraxial analgesia.

Keywords

ANALGESIA, ANALGESIA, ANALGESIA

Referencias

Wong CA. Epidural and Spinal Analgesia: Anesthesia for Labor and Vaginal Delivery. Obstetric Anesthesia: Principles and Practice. 2009:429-492.

Volmanen P, Sarvela J, Akural EI. Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain in early labour: a randomised, controlled, double blinded study. Acta Anaesthesiol Scand. 2008;52:249-255.

Roelants F, De Franceschi E, Veyckemans F. Patient-controlled intravenous analgesia using remifentanil in the parturient. Can J Anaesth. 2001;48:175-178.

Hill D. The use of remifentanil in obstetrics. Anesthesiol Clin. 2008;26:169-182.

Jenkins JG. Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a prospective study of 145,550 epidurals. Int J Obstet Anesth. 2005;14:37-42.

Elbourne D, Wiseman RA. WITHDRAWN: types of intra-muscular opioids for maternal pain relief in labour. Cochrane Database Syst Rev. 2007.

Evron S, Ezri T. Options for systemic labor analgesia. Curr Opin Anaesthesiol. 2007;20:181-185.

Irestedt L. Current status of nitrous oxide for obstetric pain relief. Acta Anaesthesiol Scand. 1994;38:771-772.

Blair JM, Hill DA, Fee JP. Patient-controlled analgesia for labour using remifentanil: a feasibility study. Br J Anaesth. 2001;87:415-420.

Hill D. Remifentanil patient-controlled analgesia should be routinely available for use in labour. Int J Obstet Anesth. 2008;17:336-339.

Hill D. Remifentanil in obstetrics. Curr Opin Anaesthesiol. 2008;21:270-274.

Kan RE, Hughes SC, Rosen MA. Intravenous remifentanil: placental transfer, maternal and neonatal effects. Anesthesiology. 1998;88:1467-1474.

Fukuda K. Opioids. Miller's Anesthesia. 2010.

Volikas I, Butwick A, Wilkinson C. Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour. Br J Anaesth. 2005;95:504-509.

Volmanen P, Akural EI, Raudaskoski T. Remifentanil in obstetric analgesia: a dose-finding study. Anesth Analg. 2002;94:913-917.

Volmanen P, Akural E, Raudaskoski T. Comparison of remifentanil and nitrous oxide in labour analgesia. Acta Anaesthesiol Scand. 2005;49:453-458.

Evron S, Glezerman M, Sadan O. Remifentanil: a novel systemic analgesic for labor pain. Anesth Analg. 2005;100:233-238.

Waring J, Mahboobi SK, Tyagaraj K. Use of remifentanil for labor analgesia: the good and the bad. Anesth Analg. 2007;104:1616-1617.

Balki M, Kasodekar S, Dhumne S. Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens. Can J Anaesth. 2007;54:626-633.

Videira RL, Cruz JRS. Remifentanil na prática clínica. Rev Bras Anestesiol. 2004;54:114-128.

Servin FS. Remifentanil: an update. Curr Opin Anaesthesiol. 2003;16:367-372.

Silva YP, Gomez RS, Marcatto JO. Early awakening and extubation with remifentanil in ventilated premature neonates. Pediatr Anesth. 2008;18:176-183.

Anand KJ, Soriano SG. Anesthetic agents and the immature brain: are these toxic or therapeutic?. Anesthesiology. 2004;101:527-530.

Jones R, Pegrum A, Stacey RGW. Patient-controlled analgesia using remifentanil in the parturient with thrombocytopaenia. Anaesthesia. 1999;54:461-465.

Olufolabi AJ, Booth JV, Wakeling HG. A preliminary investigation of remifentanil as a labor analgesic. Anesth Analg. 2000;91:606-608.

Owen MD, Poss MJ, Dean LS. Prolonged intravenous remifentanil infusion for labor analgesia. Anesth Analg. 2002;94:918-919.

Blair JM, Dobson GT, Hill DA. Patient controlled analgesia for labour: a comparison of remifentanil with pethidine. Anaesthesia. 2005;60:22-27.

Thurlow JA, Laxton CH, Dick A. Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour. Br J Anaesth. 2002;88:374-378.

Hodnett ED. Pain and women's satisfaction whit the experience of childbirth: a systematic review. Am J Obstet Gynecol. 2002;186(^s5):S160-172.

D'Onofrio P, Novelli AM, Mecacci F. The efficacy and safety of continuous intravenous administration of remifentanil for birth pain relief: an open study of 205 parturients. Anesth Analg. 2009;109:1922-1924.

Remifentanil em analgesia para o trabalho de parto

Remifentanil as analgesia for labor

Eliane C S Soares; Michelle R Lucena; Renata C Ribeiro; Letícia L Rocha; Walkíria W Vilas Boas

Resumo

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Abstract

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