***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND : Safe and effective alternatives are required in labor when epidural analgesia is not appropriate . We hypothesized that patient-controlled IV remifentanil labor analgesia would not be inferior to patient-controlled epidural labor analgesia . METHODS : This r and omized nonblinded controlled noninferiority study in healthy women with a singleton fetus and vertex presentation was performed at 1 site . Women were r and omized to receive patient-controlled IV analgesia titrated from 20 mcg up to a maximum bolus dose of 60 mcg with a lockout interval of 1 to 2 minutes , or patient-controlled epidural analgesia 0.1 % bupivacaine with 2 mcg/mL fentanyl ( initiation bolus 15 mL ; maintenance bolus 10 mL , lockout interval 20 minutes , basal infusion 5 mL/h ) . Crossover was permitted after 30 minutes . The primary study outcome was efficacy ( assessed as hourly numerical rating scale [ NRS ] pain score [ 11-point NRS ] and maternal satisfaction [ 11-point NRS ] ) ; the secondary outcome was safety ( maternal apnea ) . Supplementary oxygen was administered continuously during the respiratory monitoring period . During the first hour of analgesia , the heart rate , respiratory rate , pulse oximetry ( SpO2 ) , and end-tidal CO2 , as an indication of apnea , were compared . Apnea lasting > 40 seconds was managed by light stimulation by the attending anesthesiologist . RESULTS : Forty women were recruited to the following groups : remifentanil n = 19 ( 1 exclusion ) ,  epidural  n = 20 . Four crossed over : 3 from the remifentanil to epidural group and 1 from the epidural to remifentanil group . Mean ( ± SD ) baseline NRS pain scores were similar , 8.4 ± 1.5 for remifentanil and 8.7 ± 1.2 for epidural analgesia , P = 0.52 . Baseline adjusted mean NRS reduction at 30 minutes for remifentanil was −4.5 ( ± 0.6 ) vs −7.1(± 0.6 ) for epidural analgesia , P < 0.0001 for both . Pain score at 30 minutes was 3.7 ± 2.8 for remifentanil and 1.5 ± 2.2 for epidural analgesia , P = 0.009 . Remifentanil was inferior to epidural analgesia with respect to the NRS at all time points , because the observed difference in NRS was greater than the expected −1.5 units . Maternal satisfaction was 8.6 ± 1.4 for the remifentanil group and 9.1 ± 1.5 for epidural group , P = 0.26 . Mean respiratory rate was lower in the remifentanil group , 18 ± 4 vs 21 ± 4 breaths/min in the epidural group , P = 0.03 . Mean SpO2 was lower in the remifentanil group 96.8 % ± 1.4 vs 98.4 ± 1.2 for epidural group , P < 0.0001 . There were 9 apnea events ; all occurred in 5 women receiving remifentanil ( 5/19 [ 26.3 % ] , P = 0.046 ) . Apgar scores and neonatal respiratory outcomes were similar . CONCLUSION : IV remifentanil is inferior to epidural analgesia for provision of labor analgesia ; however , remifentanil does provide a satisfactory level of labor analgesia . Laboring women receiving remifentanil require suitable monitoring to detect and alert for apnea BACKGROUND Childbirth is an important life event for which a positive experience is important to many women . METHODS As secondary outcomes from the r and omised controlled Comparative Obstetric Mobile Epidural Trial , various aspects of satisfaction were assessed in women who had one of three types of regional analgesia ( two of which were low-dose techniques and a high-dose control using 0.25 % epidural bupivacaine ) and a comparison group who did not have epidural analgesia , shortly after delivery and 12 months later . RESULTS The predominant finding was satisfaction with spontaneous vaginal delivery whatever the mode of analgesia . The overall immediate and long-term satisfaction was similar for all three neuraxial techniques . Satisfaction with the speed of pain relief and the amount of mobility were significantly greater for the combined spinal-epidural technique compared with the low-dose infusion ( P<0.001 ) . The degree of control felt by women who had combined spinal-epidural analgesia was greater than with the high-dose ( P<0.05 ) . Women in the non-epidural comparison group did not report a greater feeling of control . Among those who delivered spontaneously , more women in the combined spinal-epidural group ( 30 % ) felt in full control compared with the high-dose group ( 17 % ) ( P<0.05 ) . By comparison 22 % in the low-dose infusion group and only 15 % who had no epidural felt in full control . CONCLUSIONS Whilst satisfaction with the experience of childbirth appears intimately related to the attainment of a spontaneous delivery , mobile epidurals enhance women 's feeling of control in labour and are popular for future choice of regional analgesia We have compared the minimum local analgesic concentrations ( MLAC ) of levobupivacaine relative to racemic bupivacaine in a prospect i ve , r and omized , double-blind , sequential allocation study . Women in labour were given a 20-ml bolus of epidural levobupivacaine or bupivacaine diluted to a concentration determined by up-down sequential allocation . The initial concentration was 0.07 % w/v for both drugs . Efficacy was defined using a visual analogue pain score ( VAPS ) at 10 mm or less within 30 min . The MLAC of levobupivacaine was 0.083 % w/v ( 95 % CI 0.065 - 0.101 ) and the MLAC of bupivacaine 0.081 % w/v ( 95 % CI 0.055 - 0.108 ) . In molar terms , the MLAC of levobupivacaine was 2.87 mmol litre-1 ( 95 % CI 2.25 - 3.49 ) and the MLAC of bupivacaine 2.49 mmol litre-1 ( 95 % CI 1.69 - 3.32 ) . With regard to the commercial preparations , the potency ratio levobupivacaine : bupivacaine was 0.98 ( 95 % CI 0.67 - 1.41 ) , and this is unlikely to be of clinical relevance . In molar terms , the ratio was 0.87 ( 95 % CI 0.60 - 1.25 ) . With regard to toxicity , the evidence should be evaluated in the light of a possible 13 % potency difference in molar concentration in favour of racemic bupivacaine We have compared three techniques used to provide extradural analgesia during the first stage of labour : 0.25 % plain bupivacaine 10 ml dem and top-ups delivered by the midwife ; continuous infusion of 0.125 % plain bupivacaine 10 ml h-1 ; and patient-controlled extradural analgesia ( PCEA ) delivering 3-ml boluses of 0.25 % bupivacaine . Each technique produced comparable analgesia achieving equivalent maternal satisfaction , with no difference in mode of delivery and no complications . This regimen for  PCEA  proved a viable alternative for continuous extradural analgesia and was popular with the mothers , midwives and anaesthetists We have studied the complications associated with three techniques used to maintain extradural analgesia in labour :  midwife top-up doses of 0.25 % bupivacaine 10 ml , continuous infusion of 0.125 % bupivacaine 10 ml h-1 and patient-controlled extradural analgesia ( PCEA ) with self-administered 3-ml bolus doses of 0.25 % bupivacaine . A significantly higher intervention rate by an anaesthetist was required in the continuous infusion group . There was no difference in the mode of delivery between the three groups , although some women in the continuous infusion group had significantly denser motor block . There was a similar incidence of rectal pressure , unilateral block and missed segments in the three groups . Uneventful hypotension occurred in three women ; two receiving PCEA and one receiving continuous infusion . Ten women experienced sensory blocks extending above T7 with no ill effects ; seven receiving PCEA and three continuous infusion G*Power is a free power analysis program for a variety of statistical tests . We present extensions and improvements of the version introduced by Faul , Erdfelder , Lang , and Buchner ( 2007 ) in the domain of correlation and regression analyses . In the new version , we have added procedures to analyze the power of tests based on ( 1 ) single- sample tetrachoric correlations , ( 2 ) comparisons of dependent correlations , ( 3 ) bivariate linear regression , ( 4 ) multiple linear regression based on the r and om predictor model , ( 5 ) logistic regression  , and ( 6 ) Poisson regression . We describe these new features and provide a brief introduction to their scope and h and ling We have used the technique of r and omized , double-blind sequential allocation to compare the minimum local analgesic concentrations ( MLAC ) of epidural bupivacaine and ropivacaine for women in the first stage of labour . The test bolus was 20 ml of local anaesthetic solution . The concentration was determined by the response of the previous woman to a higher or lower concentration of local anaesthetic , according to up-down sequential allocation . Efficacy was assessed using a 100-mm visual analogue pain score ( VAPS ) . The test solution had to achieve a VAPS of 10 mm or less to be judged effective . For bupivacaine , MLAC was 0.093 ( 95 % CI 0.076 - 0.110)% w/v , and for ropivacaine , 0.156 ( 95 % CI 0.136 - 0.176)%w/v ( P < 0.0001 , 95 % CI difference 0.036 - 0.090 ) . The analgesic potency of ropivacaine was 0.60 ( 0.47 - 0.75 ) relative to bupivacaine . Cl aims for reduced toxicity and motor block must be considered with differences in analgesic potency in mind The aim of this study was to determine the effect on the instrumental delivery rate of two different concentrations of bupivacaine combined with fentanyl in epidural infusions during labour . Only primiparous women in whom a spontaneous vaginal delivery was anticipated , were included in the study . Those women receiving a higher concentration of bupivacaine and therefore a greater amount of local anaesthetic agent during labour were significantly more likely to have an instrumental delivery with Kiell and 's rotational forceps ( p < 0.01 ) . Those women receiving a lower concentration and smaller amount of bupivacaine were significantly more likely to have an instrumental delivery with Neville‐Barnes forceps ( p < 0.05 ) . This provides evidence to support the theory that epidural analgesia may contribute to inadequate rotation of the presenting fetal part due to weakened pelvic floor muscles and that this is more likely to occur when higher concentrations of bupivacaine are used and a greater degree of motor block occurs OBJECTIVE To explore the effect of patient-controlled lumbar epidural combined anesthesia with Doula for labor analgesia with ropivacaine and sufentanil , and its influence on the progress of labor , and outcomes of mother and infant . MATERIAL S AND METHODS Two hundred parturients that requested labor analgesia were r and omly selected by patient-controlled lumbar epidural combined anesthesia with Doula as the observation group , meanwhile another 200 parturients were selected as the control group without any analgesic measurements . Labor pain score , labor duration , blood gas analysis results , the incidence of cesarean section , neonatal asphyxia , and postpartum hemorrhage were compared between the two groups . RESULTS Compared with the control group , labor analgesic effect was remarkable , the cesarean section rate was significantly reduced in observation group , and the difference was statistically significant ( p < 0.05 ) , but with respect to the duration of labor , maternal , postpartum hemorrhage , and neonatal asphyxia , there was no statistical significance between the two groups ( p > 0.5 ) . In the observation group regarding maternal and neonatal blood gas analysis results , PO2 was higher and PCO2 was lower than those in the control group . The differences were statistically significant ( p < 0.05 ) . CONCLUSION Labor analgesia by patient-controlled lumbar epidural combined anesthesia accompanied with Doula with ropivacaine and sufentanil is effective , safe , reliable , has no adverse effects , and reduces cesarean section rate Background and objective To compare the analgesic efficacy and side-effects of remifentanil intravenous patient-controlled analgesia ( IVPCA ) with walking epidural analgesia ( EDA ) during labour . Methods Thirty-nine parturient patients of mixed parity , with normal singleton pregnancies , were r and omised to receive either  remifentanil IVPCA  ( RA group ) or EDA ( EA group ) . The epidural solution contained ropivacaine 1 mg ml−1 and fentanyl 2 & mgr;g ml 
    Output:
    
: Compared with nonepidural analgesia , epidural analgesia with LCLAs is not associated with a prolonged duration of the second stage of labor or an increased instrumental birth rate .