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Epidural may beat patient-controlled painkiller for childbirth

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MONDAY, Feb. 3, 2014 (HealthDay News) -- Epidurals are better pain relievers during labor than patient-controlled doses of a fast-acting painkiller called remifentanil, new research suggests.

The Dutch study is scheduled for presentation Friday at the annual meeting of the Society for Maternal-Fetal Medicine in New Orleans.

In a meeting news release, study author Dr. Liv Freeman, of Leiden University Medical Center, said pain relief during childbirth was "significantly better" for patients who received epidurals compared to those who received remifentanil.

At issue is pain during labor, which often is alleviated through the use of epidural pain relief. The study tested an alternative approach using remifentanil, a short-acting pain reliever, since some studies suggest it works as well as epidurals.

Remifentanil works quickly and wears off quickly, according to the Society for Maternal-Fetal Medicine, so patients can control how much they take intravenously, adjusting levels every few minutes if needed.

In the new study, researchers surveyed several hundred Dutch women who received pain relief during vaginal birth after being randomly assigned to get an epidural or the painkilling drug.

Those who received epidurals tended to report more pain relief than those who received the self-administered painkiller, and 13 percent actually switched to an epidural after initially taking the drug, Freeman's team said.

One expert said the study supplies valuable new information.

"Previous studies looking at patient-controlled [painkillers] in labor have been inconclusive due to small sample sizes," said Dr. Keith Eddleman, director of obstetrics at Mount Sinai Hospital in New York City. "This study had a large number of patients and shows decisively that epidurals provide more patient satisfaction than patient-controlled [painkillers] in laboring women."

That doesn't mean epidurals are for everyone, however, since "even in the patient-controlled [painkiller] group, pain satisfaction was reasonable," Eddleman said.

"This may be important information in centers where epidural anesthesia is not readily available," he said. "In centers where both are available, patients can use this data to make an informed decision about pain relief given their individual situation."

Experts note that findings presented at medical meetings typically are considered preliminary until published in a peer-reviewed journal.

More information

There's more on pain relief during childbirth at the March of Dimes .

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