Highlights
- •Remifentanil patient-controlled intravenous analgesia is increasingly used for pain relief in labor.
- •Remifentanil provides inferior pain relief when compared to neuraxial analgesia.
- •Remifentanil can produce respiratory depression in parturients.
- •Remifentanil should only be used with appropriate safety precautions.
Abstract
This manuscript reviews the available literature on remifentanil patient-controlled
intravenous analgesia in labor focusing on efficacy and safety. Remifentanil compares
favorably to other potent systemic opioids but with fewer opioid-related neonatal
effects. However, remifentanil provides modest and short-lasting labor analgesia that
is consistently inferior when compared to neuraxial analgesia. The initial analgesic
effect provided with remifentanil also diminishes as labor progresses. In several
studies, remifentanil induced significant respiratory depressant effects in laboring
women with episodes of desaturation, hypoventilation and even apnea. Given the safety
concerns, we recommend that remifentanil patient-controlled intravenous analgesia
should not be a routine analgesia technique during labor. In cases where neuraxial
analgesia is refused or contraindicated and the use of remifentanil justified, continuous
and careful monitoring is required to detect respiratory depression to provide safe
care of both the pregnant woman and unborn child.
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References
- Measured context-sensitive half-times of remifentanil and alfentanil.Anesthesiology. 1995; 83: 968-975
- Intravenous remifentanil: placental transfer, maternal and neonatal effects.Anesthesiology. 1998; 88: 1467-1474
- Modified patient-controlled remifentanil bolus delivery regimen for labour pain.Anaesthesia. 2013; 68: 245-252
- Maternal and neonatal effects of remifentanil at induction for general anesthesia for caesarean delivery: a randomized, double-blind, controlled trial.Anesthesiology. 2006; 104: 14-20
- Electrohysterography may be integral to remifentanil labor analgesia.J Matern Fetal Neonatal Med. 2012; 25: 151-152
- Novel vital signs-controlled, patient-assisted intravenous analgesia using remifentanil for labour and delivery.Int J Obstet Anesth. 2014; 23: 196-198
- Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens.Can J Anesth. 2007; 54: 626-633
- Intravenous patient-controlled analgesia for labour: a survey of UK practice.Int J Obstet Anesth. 2007; 16: 221-225
- Analgesia for labour: a survey of Norwegian practice – with a focus on parenteral opioids.Acta Anaesthesiol Scand. 2009; 53: 794-799
- Geburtshilfliche.Anaesthesist. 2011; 60: 995-1001
- Enquete nationale sur l’utilisation du remifentanil comme alternative a l’analgesie peridurale obstetricale dans les maternites de niveau II et III.Ann Fr Anesth Reanim. 2012; 31: 682-686
- Patient controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short acting opioid remifentanil: survey in the French part of Belgium.Acta Anaesthesiol Belg. 2009; 60: 75-82
RemiPCA SAFE Network by the Swiss Association of Obstetric Anaesthesia; www.remipca.org [accessed December 2015].
American College of Cardiology Foundation. Methodology Manual and Policies from the ACCF/AHA Task Force on Practice Guidelines. http://assets.cardiosource.com/Methodology_Manual_for_ACC_AHA_Writing_Committees.pdf [accessed December 2015].
- The use of remifentanil for Cesarean section in a parturient with recurrent aortic coarctation.Can J Anesth. 2000; 47: 454-459
- Patient controlled analgesia in labour using remifentanil in two parturients with platelet abnormalities.Br J Anaesth. 2000; 84: 411-413
- Patient controlled intravenous analgesia using remifentanil in the parturient.Can J Anesth. 2001; 48: 175-178
- Patient controlled analgesia using remifentanil in the parturient with thrombocytopenia.Anaesthesia. 1999; 54: 461-465
- A preliminary investigation of remifentanil as a labor analgesic.Anesth Analg. 2000; 91: 606-608
- Patient-controlled analgesia for labour using remifentanil: a feasibility study.Br J Anaesth. 2001; 87: 415-420
- Remifentanil in obstetric analgesia: a dose-finding study.Anesth Analg. 2002; 94: 913-917
- Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour.Br J Anaesth. 2005; 95: 504-509
- Efficacy and side-effects of intravenous remifentanil patient-controlled analgesia used in stepwise approach for labour: an observational study.Int J Obstet Anesth. 2013; 22: 19-25
- The efficacy and safety of continuous intravenous administration of remifentanil for birth pain relief: an open study of 205 parturients.Anesth Analg. 2009; 109: 1922-1924
- Nitrous oxide for the management of labor pain: a systematic review.Anesth Analg. 2014; 118: 153-167
- Comparison of remifentanil and nitrous oxide in labour analgesia.Acta Anaesthesiol Scand. 2005; 49: 453-458
- Comparison of remifentanil: Entonox with Entonox alone in labor analgesia.Adv Biomed Res. 2013; 2: 87-92
- A double blinded randomised placebo-controlled study of intramuscular pethidine for pain relief in the first stage of labour.BJOG. 2004; 111: 648-655
- Lack of analgesic effect of systemically administered morphine or pethidine on labor pain.BJOG. 1996; 103: 968-972
- Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor.Int J Gynecol Obstet. 2003; 83: 19-27
- A comparison of pethidine and remifentanil patient-controlled analgesia in labour.Int J Obstet Anesth. 2001; 10: 86-90
- Remifentanil by patient controlled analgesia compared with intramuscular meperidine for pain relief in labour.Br J Anaesth. 2002; 88: 374-378
- Patient controlled analgesia for labour: a comparison of remifentanil with pethidine.Anaesthesia. 2005; 60: 22-27
- Remifentanil: a novel systemic analgesic for labor pain.Anesth Analg. 2005; 100: 233-238
- Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour.Br J Anaesth. 2010; 104: 209-215
- A double-blind randomised comparison of intravenous patient-controlled remifentanil with intramuscular pethidine for labour analgesia.Anaesthesia. 2011; 66: 796-801
- Remifentanil versus fentanyl for intravenous patient-controlled labor analgesia: an observational study.Can J Anesth. 2012; 59: 246-254
- A comparison between remifentanil and meperidine for labor analgesia: a systematic review.Anesth Analg. 2011; 113: 818-825
- Remifentanil for labour analgesia: a meta-analysis of randomized controlled trials.Eur J Anaesthesiol. 2012; 29: 177-185
- Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double-blinded study.Acta Anaesthesiol Scand. 2008; 52: 249-255
- A randomised comparison of intravenous remifentanil patient controlled analgesia with epidural ropivacaine/sufentanil during labour.Int J Obstet Anesth. 2011; 20: 118-123
- Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women.Arch Gynecol Obstet. 2012; 286: 1375-1381
- Labour analgesia: a randomised, controlled trial comparing intravenous remifentanil and epidural analgesia with ropivacaine and fentanyl.Eur J Anaesthesiol. 2012; 29: 129-136
- Comparison of parturient-controlled remifentanil with epidural bupivacaine and sufentanil for labour analgesia: randomised, controlled trial.Biomed Pap Med Fac Univ Palacky Olomouc Czech Republic. 2012; 156: 1-6
- A comparison of remifentanil parturient-controlled intravenous analgesia with epidural analgesia: a meta-analysis of randomized controlled trials.Anesth Analg. 2014; 118: 598-603
- Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.PLoS One. 2014; 9: e112283
- A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient controlled epidural analgesia in laboring women.Anesth Analg. 2013; 118: 589-597
- Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial.BMJ. 2015; 350: h846
- Remifentanil for labour analgesia: a double-blinded, randomised controlled trial of maternal and neonatal effects of patient-controlled analgesia versus continuous infusion.Anaesthesia. 2013; 68: 236-244
- Can remifentanil use in obstetrics be improved by optimal patient-controlled analgesia bolus timing?.Br J Anaesth. 2015; 114: 281-289
- Timing of intravenous patient-controlled remifentanil bolus during early labour.Acta Anaesthesiol Scand. 2011; 55: 486-494
- Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: a randomized, double-blind comparison with diazepam.Anesth Analg. 2005; 101: 251-258
- Remifentanil patient-controlled analgesia should be routinely available for use in labour: con.Int J Obstet Anesth. 2009; 17: 339-342
- Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia.Anaesthesia. 2012; 67: 538-540
- Emergency bedside cesarean delivery: lessons learned in teamwork and patient safety.BMC Res Notes. 2012; 5: 412-416
- Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia.Anaesthesia. 2013; 68: 283-287
- Respiratory depression after neuraxial opioids in the obstetric setting.Anesth Analg. 2007; 107: 956-961
- Remifentanil for labour analgesia: time to draw breath?.Anaesthesia. 2013; 68: 231-235
Article info
Publication history
Published online: December 21, 2015
Accepted:
December 12,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
