| Abstract | | Background: Numerous studies and our own experience have shown extremely wide range of effective remifentanil bolus doses, a need for careful continours monitoring and frequent adjusting of bolus doses to provide sufficient analgesia and to avoid possible serious side effects. To improve analgesic efficiency and satisfaction during treatment with remifentanil and to make dosing of the drug easier, we invented a modified delivery regimen that was supposed to better suit pain profile during contractions. The main differences to the standard one were in bolus infusion rates and variable bolus dosing. Methods: Healthy parturients with normal pregnancy and estimatedlow risk for childbirth were included. Every partiurrient received both regimens in alternating blocks, each with 5 contractions. There was no control group. We derived a pair of values (one for each regimen) for every observed parameter. These values were mean or median of all values that were obtained using a specified regimen in particular parturient. The blocks were compared for pain and satisfaction scores, maternal and fetal vital parameters, side effects and other events. We designed a computer guided infusion pump that was able to deliver remifentanil according with our protocol. Student T-test or Mann-Whitney's U-test were used as appropriate. Results: 23 parturients were included and completed the study. There were no statistically significant differences in observed maternal and fetal vital parameters and in side effects. Comparing bolus doses and pain scores for separate contractions within the blocks, we found that in standard regimen they tended to rise, while in the modified, the changes were ledd obvious. Bolus doses in stnadard regimen increased in time as there was a need to manually adjust them, while in modified regimen they changed very little. Parturients preferred the modified regimen to the standard one in both pain (78 %) and satisfaction (65 %) estimates. (Abs. trunc. at 2000 ch.)
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