Satisfaction and Outcomes with Patient-Controlled Intravenous Analgesia of Remifentanil for Labor Analgesia at a Specialist Maternity Hospital in Singapore: A Retrospective Observational Study

Abstract

Background: Patient-controlled intravenous analgesia (PCIA) remifentanil is being increasingly adopted for labor analgesia despite efficacy and safety concerns. This retrospective observational study aimed to describe factors associated with high versus low parturient satisfaction, adverse effects, and parturient and neonatal outcomes in a specialist maternity hospital in Singapore. Materials and Methods: Database review of patients who received PCIA remifentanil for labor analgesia between 2014 and 2020 were analyzed retrospectively. Parturient and clinical characteristics, adverse events, parturient and neonatal outcomes, satisfaction, PCIA remifentanil settings, and usage characteristics were analyzed. Results: There were 177 parturients who received PCIA remifentanil during the study period, with a trend of increasing utilization. After excluding 31 parturients, 146 were analyzed, of whom 99 (67.8%) reported satisfaction scores of ≥80 out of 100, with a mean ± standard deviation of 89.5 ± 8.9. Univariate analysis showed that higher pain scores at delivery was associated with low satisfaction scores (unadjusted odds ratio 1.39, 95% confidence intervals 1.02-1.88). None of the parturients or neonates required ventilation or cardiopulmonary resuscitation. Oxygen desaturation (SpO 2 < 95%) was observed in 10.3% of parturients (n = 15), all of which were self-limiting. Conclusion: PCIA remifentanil for labor analgesia resulted in high satisfaction with no severe adverse events. Standardized protocols for PCIA settings and close monitoring may improve parturient and fetal safety. Future research should focus on improving the analgesic efficacy of PCIA remifentanil and monitoring practices to reduce the risk of severe adverse events.