Patient opinion of analgesia during external cephalic version at term in singleton pregnancy

Abstract

To assess the opinion and the level of satisfaction of patients concerning analgesia during external cephalic version (ECV), we present the results of a survey of 120 women undergoing ECV at term during a randomised controlled trial (July 2012 to February 2013) comparing remifentanil and nitrous oxide. Overall, 110 (91.7%) women said they would repeat the procedure and 111 (92.5%) that they would recommend it to another pregnant woman, with no significant differences by type of analgesia. The administration and sense of comfort were rated better in the remifentanil group (p < .01). In conclusion, the use of analgesia during ECV is associated with a high rate of willingness among women to repeat the procedure and recommend it to other pregnant women.

Impact statement

• What is already known on this subject? ECV is commonly a painful manoeuvre for the woman. This pain triggers maternal reactive abdominal muscle contraction and involuntary abdominal tensing, reducing the likelihood of successful version and causing some women to reject the technique.

• What do the results of this study add? The use of analgesia during ECV is associated with a high rate of willingness among women to repeat the procedure and recommend it to other pregnant women. The sense of comfort during ECV was also significantly better in the remifentanil group, probably because of its greater analgesic power and greater comfort during its administration.

• What are the implications of these findings for clinical practice and/or further research? ECV should be carried out under analgesia, when available, not only to decrease pain but also to encourage wider adoption of the technique and enable more women to benefit from it.

Keywords:

• Analgesia
• anaesthesia
• breech presentation
• nitrous oxide
• pregnancy
• remifentanil
• external cephalic version

Author contributions

JB, JIP, CO, LR, RS, and TMA conceived and designed the study. CO, LR, MMC, RS, AJ, IA, IM and JCM were responsible for recruitment, acquisition of data and perform the experiments. JB, JIP, CO and PC analysed the data. JB, JIP, and JCM contributed reagents/materials/analysis tools. LR, CO, JB, JIP, PC, MMC, RS, AJ, IM, and IA were involved in writing and TMA, and JCM were involved in revising the article.

Disclosure statement

The authors did not report any potential conflicts of interest.

Additional information

Funding

This study was sponsored by an Independent Clinical Research Grant from the Ministry for Health and Consumer Affairs, Spanish Government, Spain.