Induction opioids during C-section do not affect delivery, neonatal outcomes

Induction opioids such as alfentanil and remifentanil do not appear to impact Apgar scores and neonatal airway outcomes after caesarean section, reports a recent meta-analysis.

After applying the selection criteria, 17 studies remained eligible for analysis. These studies comprised a total of 978 patients treated with either remifentanil, alfentanil or fentanyl and whose outcomes were compared against placebo controls. The databases accessed were the Cochrane trials registry, CINAHL, PubMed, Web of Science, SCOPUS and Medline.

Twelve studies evaluated Apgar scores at 1 minute after giving birth. Induction opioids did lead to significant changes (weighted mean difference [WMD], –0.05, 95 percent confidence interval [CI], –0.23 to 0.13; p=0.60).

Disaggregating according to opioid type yielded the same result: remifentanil (WMD, –0.27, 95 percent CI, –0.74 to 0.19; p=0.25), alfentanil (WMD, 0.05, 95 percent CI, –0.12 to 0.21; p=0.58) and fentanyl (WMD: –0.02, 95 percent CI, –0.30 to 0.26; p=0.89). Apgar scores at 5 minutes postdelivery were similarly unaffected by the overall use of induction opioids, or the use of specific types, except for fentanyl (WMD, –0.20, 95 percent CI, –0.33 to –0.08; p=0.002).

Induction opioids were likewise unrelated to the need for neonatal respiratory interventions. Remifentanil, for instance, did not significantly increase the likelihood of using bag-mask ventilation (risk ratio [RR], 1.41, 95 percent CI, 0.88–2.39; p=0.71), neonatal intubation rate (RR, 1.34, 95 percent CI, 0.67–2.68; p=0.97) and neonatal intensive care unit (NICU) admission (RR, 0.95, 95 percent CI, 0.77–1.19; p=0.67).