Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was performed by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from inception to April 2019. All randomized controlled trials (RCTs) investigating the risk of intrapartum maternal fever with RPCA compared with EA alone or EA in combination with spinal analgesia during labor were included. A total of 825 studies were screened, and 6 RCTs including 3341 patients were identified. Compared with EA, RPCA was associated with a significantly lower incidence of intrapartum maternal fever (risk ratio [RR] 0.48, P = 0.02, I2 = 49%) during labor analgesia. After excluding 2 trials via the heterogeneity analysis, there was no difference in the incidence of intrapartum fever between patients receiving RPCA and those receiving EA. Satisfaction with pain relief during labor was lower in the RPCA group than that in the EA group (− 10.6 [13.87, − 7.44], P < 0.00001, I2 = 0%). The incidence of respiratory depression was significantly greater in the RPCA group than that in the EA group (risk ratio 2.86 [1.65, 4.96], P = 0.0002, I2 = 58%). The incidence of Apgar scores < 7 at 5 min in the RPCA group was equivalent to that in the EA group. There is no solid evidence to illustrate that the incidence of intrapartum maternal fever is lower in patients receiving intravenous RPCA than in patients receiving EA.

中文翻译：

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瑞芬太尼患者自控镇痛与硬膜外镇痛对产妇产后发热的系统评价和荟萃分析

静脉瑞芬太尼患者自控镇痛（RPCA）是缓解产后疼痛的硬膜外镇痛（EA）的替代方法。但是，在降低分娩期间产妇产后发热的风险方面，RPCA是否优于EA仍是未知的。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，从开始到2019年4月，通过搜索PubMed，EMBASE和Cochrane中心的对照试验进行了系统的综述和荟萃分析。所有随机对照试验（RCTs）包括调查与产程中单独使用EA或使用EA并用脊柱镇痛相比较的RPCA产妇发热的风险。筛选了825项研究，确定了6项RCT，包括3341例患者。与EA相比，在分娩镇痛过程中，RPCA与产妇产后发热的发生率显着降低（风险比[RR]为0.48，P = 0.02，I2 = 49％）相关。通过异质性分析排除了2个试验后，接受RPCA的患者和接受EA的患者的分娩发烧发生率没有差异。RPCA组对分娩期间疼痛缓解的满意度低于EA组（-10.6 [13.87，-7.44]，P <0.00001，I2 = 0％）。RPCA组的呼吸抑制发生率明显高于EA组（风险比2.86 [1.65，4.96]，P = 0.0002，I2 = 58％）。RPCA组在5分钟内Apgar得分<7的发生率与EA组相同。