Background: Epidural analgesia is considered the most effective method for maternal pain relief during labor. However, remifentanil patient-controlled analgesia (PCA) serves as an important alternative when epidural analgesia is contraindicated, unavailable, or refused by the patient. Understanding the comparative effectiveness and safety of these two methods is essential for guiding clinical decision-making.

Aim of the Study: The study aimed to compare epidural analgesia with intravenous remifentanil PCA in terms of analgesic effectiveness, maternal safety, labor progression, side effects, and neonatal outcomes.

Materials and Methods: A total of 46 term pregnant women were recruited; two were excluded due to fetal bradycardia requiring cesarean section. The remaining 44 participants were assigned to the epidural group (23 women) or the PCA group (21 women). The epidural group received bupivacaine 0.125%, while the PCA group received intravenous remifentanil with programmed lockout intervals. Pain intensity (NRS score), labor duration, maternal physiological responses, and neonatal outcomes were assessed.

Results: The epidural group showed significantly lower NRS pain scores (1.55±1.52 vs. 4.46±2.16). The PCA group demonstrated shorter active labor duration (130±58 vs. 198±83 minutes). Desaturation and pruritus occurred more frequently in the PCA group, whereas hypotension and increased ephedrine use were more common with epidural analgesia. No significant differences were found in nausea, vomiting, shivering, oxytocin use, neonatal ICU admission, or Apgar scores.