AnaesthesiaObstetricsPain Management

063 – Remifentanil PCA for labour analgesia – Mike, Matt & Roger

(* Hypothetical Case)

You are asked to see a pleasant 31 yr old woman in the antenatal clinic who is pregnant for the first time because as an adolescent she had an extensive scoliosis repair and now has Harrington Rods in her lumbar and thoracic spine. She tells you that she “is worried about being in a lot of pain during labour” and she wants to know what her options are.

Hi everyone,

This week three of us sat around our new AV equipment (thanks Trilby) to discuss the interesting and somewhat controversial topic of remifentanil PCA use for analgesia in labour. We discuss the history, the concerns regarding safety especially respiratory depression or apnoea, efficacy and some of the new evidence recently published.

Links

The RESPITE study in Lancet 2018 : Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial

IJOA August 2019 Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands

IJOA August 2019 Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010–2015)

BMC Pregnancy and Childbirth 2013 Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

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