INTRAVENOUS FENTANYL PCA DURING LABOR

Purpose: To evaluate the usefulness of intravenous patient-controlled analgesia (PCA) fentanyl for labour analgesia, its effectiveness for m aternal pain and safely for the fetus ana newborn. Methods: Twenty pri migravidas were randomised to receive intravenous PCA fentanyl or epid ural analgesia for labour pain. Maternal pain, heart rate and arterial oxyhaemoglobin saturation (SpO(2)) were monitored, Fetal and neonatal monitoring included cardiotocogram (CTG), APGAR, neurological scoring and static-charge-sensitive bed (SCSB) recording for 12 hr postnatall y with ECG and SpO(2). Fentanyl concentrations and pH of umbilical art ery and vein were analysed. Results: initially, epidural analgesia was more effective (P = 0.01), and three patients in the fentanyl group w ere given epidural due to unsatisfactory pain relief. Overall satisfac tion for analgesia did not differ between the groups. Maternal side-ef fects were more frequent in the fentanyl group (dizziness and tirednes s most often, P = 0.0001). Severe side-effects were not reported. in C TG there were no differences between groups. Aii the newborns were hea lthy, APC;AR and pH were normal. Naloxone was not used, Neurological s coring was similar in both groups, In 12 hr monitoring heart rate, bre athing frequency and movement time were similar in both groups, but Sp O(2) was lower in the fentanyl group (P < 0.001). Umbilical cord fenta nyl concentrations were low or beyond the detection limit. Conclusion: intravenous fentanyl can be used for labour analgesia with the doses reported here as an alternative to epidural analgesia. However, the fe tus and neonate must be appropriately monitored. Naloxone and oxygen s hould be available ii neonatal distress occurs.