• Kei Miyakoshi, Mamoru Tanaka, Hiroshi Morisaki, Seon-Hye Kim, Yuki Hosokawa, Tadashi Matsumoto, Kazuhiro Minegishi, and Yasunori Yoshimura.
• Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan. kei@z7.keio.jp
• J. Obstet. Gynaecol. Res. 2013 Apr 1; 39 (4): 783-9.

AimTo investigate perinatal outcomes, the analgesic efficacy and maternal satisfaction in nulliparous women receiving fentanyl intravenous patient-controlled analgesia (i.v.-PCA).Material And MethodsA total of 1401 nulliparous women with a singleton pregnancy who received fentanyl i.v.-PCA (i.v.-PCA group, n = 290) or no analgesia (control group, n = 1111) in labor between 2005 and 2010 were reviewed. Fentanyl i.v.-PCA was implemented on maternal request during the first stage of labor over 35 weeks of gestation, and discontinued at full cervical dilatation. Perinatal outcomes were compared between the i.v.-PCA and the control groups. The numerical rating scale (NRS) levels during labor were also examined in the i.v.-PCA group. Additionally, parturients received fentanyl i.v.-PCA in 2010 (n = 73) were asked about overall satisfaction using a scale poor, moderate, good and excellent on postpartum day 0-3.ResultsWomen receiving i.v.-PCA showed significantly longer labor and more need of oxytocin augmentation, compared with the control. Cesarean section was significantly less frequent in the i.v.-PCA group compared with the control (11.0% v.s. 24.1%, respectively), with the vacuum-assisted delivery rate comparable between groups. Neonatal outcomes (i.e. Apgar score <7 at 1 min or 5 min, umbilical artery pH <7.20) were comparable between groups, irrespective of mode of delivery. Significant reduction of NRS levels was noted until 3 h after induction of i.v.-PCA, compared to the baseline. Of the women who expressed their satisfaction, 72% (48/67) exhibited 'excellent' or 'good' for pain relief by i.v.-PCA.ConclusionFentanyl i.v.-PCA could be a useful approach for labor pain relief in nulliparas when regional blocks are unavailable.© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

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