Labor Analgesia when Neuraxial Anesthesia is Relatively Contraindicated: Comparison of Patient-Controlled Fentanyl and Intermittent Nalbuphine Boluses

Background: A patient-controlled fentanyl protocol for parturient with relative contraindications to neuraxial anesthesia was implemented. The primary goal of this study is to identify any increased risk for adverse events to the mother or fetus associated with our fentanyl PCA protocol. The primary outcome studied was maternal/fetal adverse events. Secondary outcomes studied included verbal pain score (VPS) during labor and incidence for adherence to the specified protocol. Methods: A single-center chart review of patients utilizing patient-controlled fentanyl for labor from August 2009 through August 2015 was performed to determine maternal/fetal adverse events and pain control. This group was compared to a similar group receiving intermittent nalbuphine boluses for labor analgesia. Results: There were no maternal complications observed in either group, and fetal adverse events were not significantly different between the fentanyl vs nalbuphine groups. There was a significant decrease in the verbal pain score at 2 hours in the fentanyl group (p=0.0180) and at 1 and 2 hours in the nalbuphine group (p=0.0001 and p=0.0157, respectively). The pain score was lower in the fentanyl group at 2 hours compared to the nalbuphine group. The verbal pain scores were unchanged at 3 and 4 hours in both groups compared to baseline. Conclusion: Maternal and fetal adverse events related to narcotic therapy during labor were very uncommon. Patient-controlled fentanyl is a safe and reasonable option for labor analgesia in settings where epidural analgesia is relatively contraindicated, or not desired by the parturient.