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Patient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider.

AbstractPURPOSE OF REVIEW:
Remifentanil is a relatively new but commonly used opioid alternative in the management of labor pain relief. The present article evaluates efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief.
RECENT FINDINGS:
Remifentanil PCIA provides analgesia that is superior to nitrous oxide or other opioids such as meperidine, but is less effective when compared with epidural analgesia. Recent evidence suggests it produces significant respiratory depression making routine use as first line analgesia strategy virtually impossible.
SUMMARY:
Remifentanil PCIA is a valuable analgesic strategy whenever regional analgesia is contraindicated. Using it as first line strategy seems to be contraindicated because of significant respiratory side-effects to the mother. Whenever used advanced and continuous monitoring using capnography, saturation monitoring and one-to-one midwifery care are mandatory!
AuthorsMarc Van de Velde
JournalCurrent opinion in anaesthesiology (Curr Opin Anaesthesiol) Vol. 28 Issue 3 Pg. 237-9 (Jun 2015) ISSN: 1473-6500 [Electronic] United States
PMID25827284 (Publication Type: Journal Article, Review)
Chemical References
  • Anesthetics, Intravenous
  • Piperidines
  • Remifentanil
Topics
  • Administration, Intravenous
  • Adult
  • Analgesia, Obstetrical (methods)
  • Analgesia, Patient-Controlled (methods)
  • Anesthetics, Intravenous (administration & dosage)
  • Female
  • Humans
  • Piperidines (administration & dosage)
  • Pregnancy
  • Remifentanil

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