BACKGROUND Unsatisfactory analgesia would occur frequently during repeated cesarean section under epidural anesthesia. The aim of this study is to observe the effects of intravenous remifentanil on maternal comfort, maternal and neonatal safety during repeated cesarean section under epidural anesthesia. METHODS A total of 80 parturients undergoing repeated cesarean section were involved in the study. The patients were randomly divided into the intravenous remifentanil- assisted epidural group (group R) and epidural group (group E), respectively (n = 40). In group R, the remifentanil was continuously intravenously infused as an adjuvant to epidural anesthesia. In group E, 0.75% ropivacaine epidural or intravenous ketamine was administered as needed. Parturient baseline characteristics, vital signs, VAS scores, and comfort scores during surgery were recorded. Adverse effects were also recorded. RESULTS A total of 80 patients were enrolled in the current study and the final analyses included 39 patients in group R and 38 patients in group E. No differences in patients' baseline characteristics were found between the two groups (p > 0.05). Compared with group E, the comfort score was significantly higher in group R (9.1 ± 1.0 vs. 7.5 ± 1.3, p <  0.001), whereas the maximum VAS score was significantly lower in group R (1.8 ± 1.2 vs. 4.1 ± 1.0, p <  0.001). Maternal and neonatal adverse effects did not differ between the two groups during surgery (p > 0.05). CONCLUSIONS Continuous intravenous infusion of low-dose remifentanil can significantly improve the experience of parturients undergoing repeated cesarean section under epidural anesthesia, without noticeable maternal or neonatal adverse effects. TRIAL REGISTRATION This study was pre-registered at http://www.chictr.org.cn/index.aspx (ChiCTR1800018423) on 17/09/2018.

中文翻译：

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前瞻性随机研究表明，连续静脉输注瑞芬太尼改善了硬膜外麻醉下反复剖腹产的产妇体验。

背景技术在硬膜外麻醉下重复剖宫产的过程中，经常会出现不满意的镇痛效果。这项研究的目的是观察硬膜外麻醉下重复剖宫产时静脉注射瑞芬太尼对产妇舒适性，产妇和新生儿安全的影响。方法共有80名产妇进行了重复剖宫产术。将患者随机分为静脉瑞芬太尼辅助硬膜外治疗组（R组）和硬膜外治疗组（E组）（n = 40）。在R组中，瑞芬太尼被连续静脉内输注作为硬膜外麻醉的佐剂。在E组中，根据需要给予0.75％的罗哌卡因硬膜外或静脉注射氯胺酮。产妇基线特征，生命体征，VAS分数，并记录手术期间的舒适度得分。还记录了不良反应。结果本研究共纳入80例患者，最终分析包括R组39例和E组38例。两组之间患者基线特征无差异（p> 0.05）。与E组相比，R组的舒适度评分显着更高（9.1±1.0 vs. 7.5±1.3，p <0.001），而R组的最大VAS评分显着较低（1.8±1.2 vs. 4.1±1.0， p <0.001）。两组在手术期间的母婴不良反应无差异（p> 0.05）。结论连续静脉输注小剂量瑞芬太尼可显着改善硬膜外麻醉下重复剖腹产的产妇的体验，而没有明显的产妇或新生儿不良反应。试验注册该研究已于2018年9月17日在http://www.chictr.org.cn/index.aspx（ChiCTR1800018423）上进行了预注册。