Authors: Shmuel Evron Tiberiu Ezri Michael Protianov Gleb Muzikant Oscar Sadan Amir Herman Peter Szmuk
Publish Date: 2008/05/25
Volume: 22, Issue: 2, Pages: 105-111
Abstract
Epidural analgesia is associated with hyperthermia during labor and presumably causes it although no convincing mechanism has been postulated It seems likely that fever associated with pyrogenic factors related to labor is suppressed by opioids whereas it is expressed normally in patients given epidural analgesia We examined this hypothesis and the possible etiology of temperature elevation in laborIn this prospective randomized controlled study we assessed 201 parturients during spontaneous labor Analgesia was randomly provided with one of four treatment groups 1 epidural ropivacaine alone 2 IV remifentanil alone 3 epidural ropivacaine plus IV remifentanil and 4 epidural ropivacaine plus IV acetaminophen At randomization patients were normothermic Intrapartum hyperthermia ≥38°C was correlated to the analgesic techniqueThe maximum increase in oral temperature was greatest in the ropivacaine group 07 ± 06°C and least in the remifentanil group 03 ± 04°C P = 0013 The percentage of patients who became hyperthermic ≥38°C during the first 6 h of labor was greatest in the ropivacaine group 14 and least in the remifentanilalone group 2 but the difference was not statistically significant The maximum forearmfinger gradients were lower less vasoconstriction in the remifentanil group when compared to the gradients in patients with epidural analgesia 14 ± 18 vs 30 ± 17 respectively P 0001
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