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A comparison of patient-controlled analgesia fentanyl and alfentanil for labour analgesia

From the Departments of Anaesthesia and Neonatology, St. Joseph's Health Centre, University of Western Ontario, Canada.

Dr. Pat Morley-Forster, Department of Anaesthesia, St. Joseph's Health Centre, 268 Grosvenor St, London, Ontario, N6A 4V2 Canada. Phone: 519-646-6100, x64219; Fax: 519-646-6116; E-mail: pmorleyf{at}julian.uwo.ca

Purpose: To determine the analgesic efficacy of equipotent doses of PCA (patient-controlled analgesia) fentanyl and PCA alfentanil for labour pain.

Methods: Twenty three, ASA I - II parturients between 32-42 wk gestational age in whom epidural analgesia was contraindicated were randomized to receive PCA fentanyl (Group F)or alfentanil (Group A). Plain numbered vials contained 21 ml fentanyl 50 µgml^–1 or alfentanil 500 µgml^–1. A one millilitre loading dose was administered. The PCA solution was prepared by diluting 10 ml study drug with 40 ml saline and the PCA pump was programmed to deliver a dose of 2 ml, delay of five minutes and a basal rate of 2 mlhr^–1. Maternal measurements obtained were hourly drug dose, total dose, Visual Analog Pain Score (VAPS) q 30 min, sedation score q 1 hr and side effects. Neonates were assessed by 1,5, and 10-min Apgar scores, umbilical venous and arterial blood gases and neurobehavioural scores at four and 24 hr.

Results: Mean VAPS from 7 - 10 cm cervical dilatation were higher in Group A than in Group F. (85.7 ± 13.9 vs 64.6 ± 12.1; P < 0.01) There were no inter-group differences in VAPS from 1 - 3 cm, or from 4 - 6 cm dilatation, in maternal sedation scores or side effects, or in neonatal outcomes.

Conclusion: In the doses prescribed in this study, PCA fentanyl was found to provide more effective analgesia in late first stage labour than PCA alfentanil.

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