Date of Award

Spring 5-25-2019

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Joseph Burkard, DNSc, CRNA

Abstract

Labor pain is a significant source of anxiety for most pregnant women. Parturients who are excluded from epidural analgesia (EA), the most common and most effective technique to reduce this pain, deserve access to the next best choice. Remifentanil patient controlled analgesia (RPCA), due to its fast onset, short half-life and demonstrated effect at reducing pain and boosting satisfaction is the next best option when compared to EA. Adoption of this strategy represents an opportunity to help bring this evidence based technique into a mainstream health system. This project reports on the first stage of a pilot project to bring RPCA to a medium sized obstetrical ward. Data revealed that the target patient population at this clinical site has an approximate 1.2% prevalence of parturients who are denied EA due to some comorbidity or anti-coagulant therapy. Extrapolating that figure to an annual rate would indicate that approximately 36 women per year are excluded from EA, the gold standard for pain relief during labor. Data also indicate that this subgroup is more likely to request parenteral opioids than the population of laboring women. In time, this technique should improve the labor experience for women at this clinical site and help advance the best practice throughout the United States.

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