The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor

Shmuel Evron, Tiberiu Ezri, Michael Protianov, Gleb Muzikant, Oscar Sadan, Amir Herman, Peter Szmuk

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: 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 labor. Methods: In 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 technique. Results: The maximum increase in oral temperature was greatest in the ropivacaine group (0.7 ± 0.6°C) and least in the remifentanil group (0.3 ± 0.4°C; P = 0.013). 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 remifentanil-alone group (2%), but the difference was not statistically significant. The maximum forearm-finger gradients were lower (less vasoconstriction) in the remifentanil group when compared to the gradients in patients with epidural analgesia (1.4 ± 1.8 vs 3.0 ± 1.7, respectively; P < 0.001). Conclusion: Our results are consistent with the theory that low-dose opioids inhibit fever in patients not given epidural analgesia. However, in view of the negative results, the hypothesis of epidural-induced hyperthermia may be questionable.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalJournal of Anesthesia
Volume22
Issue number2
DOIs
StatePublished - May 2008

Fingerprint

Acetaminophen
Body Temperature
Epidural Analgesia
Fever
Opioid Analgesics
Induced Hyperthermia
Temperature
Random Allocation
Vasoconstriction
Forearm
Analgesia
Fingers
Analgesics
ropivacaine
remifentanil
Parturition
Therapeutics

Keywords

  • Acetaminophen
  • Epidural
  • Hyperthermia
  • Labor
  • Remifentanil

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor. / Evron, Shmuel; Ezri, Tiberiu; Protianov, Michael; Muzikant, Gleb; Sadan, Oscar; Herman, Amir; Szmuk, Peter.

In: Journal of Anesthesia, Vol. 22, No. 2, 05.2008, p. 105-111.

Research output: Contribution to journalArticle

Evron, Shmuel ; Ezri, Tiberiu ; Protianov, Michael ; Muzikant, Gleb ; Sadan, Oscar ; Herman, Amir ; Szmuk, Peter. / The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor. In: Journal of Anesthesia. 2008 ; Vol. 22, No. 2. pp. 105-111.
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T1 - The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor

AU - Evron, Shmuel

AU - Ezri, Tiberiu

AU - Protianov, Michael

AU - Muzikant, Gleb

AU - Sadan, Oscar

AU - Herman, Amir

AU - Szmuk, Peter

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N2 - Purpose: 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 labor. Methods: In 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 technique. Results: The maximum increase in oral temperature was greatest in the ropivacaine group (0.7 ± 0.6°C) and least in the remifentanil group (0.3 ± 0.4°C; P = 0.013). 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 remifentanil-alone group (2%), but the difference was not statistically significant. The maximum forearm-finger gradients were lower (less vasoconstriction) in the remifentanil group when compared to the gradients in patients with epidural analgesia (1.4 ± 1.8 vs 3.0 ± 1.7, respectively; P < 0.001). Conclusion: Our results are consistent with the theory that low-dose opioids inhibit fever in patients not given epidural analgesia. However, in view of the negative results, the hypothesis of epidural-induced hyperthermia may be questionable.

AB - Purpose: 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 labor. Methods: In 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 technique. Results: The maximum increase in oral temperature was greatest in the ropivacaine group (0.7 ± 0.6°C) and least in the remifentanil group (0.3 ± 0.4°C; P = 0.013). 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 remifentanil-alone group (2%), but the difference was not statistically significant. The maximum forearm-finger gradients were lower (less vasoconstriction) in the remifentanil group when compared to the gradients in patients with epidural analgesia (1.4 ± 1.8 vs 3.0 ± 1.7, respectively; P < 0.001). Conclusion: Our results are consistent with the theory that low-dose opioids inhibit fever in patients not given epidural analgesia. However, in view of the negative results, the hypothesis of epidural-induced hyperthermia may be questionable.

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KW - Labor

KW - Remifentanil

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