Remifentanil for labor analgesia: an evidence-based narrative review

International Journal of Obstetric Anesthesia
M Van de Velde, Brendan Carvalho

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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Citations

Jun 15, 2016·International Journal of Obstetric Anesthesia·A MelberUNKNOWN Board Members of the Swiss Association of Obstetric Anaesthesia
Jun 15, 2016·International Journal of Obstetric Anesthesia·M Van de Velde, B Carvalho
Jul 5, 2016·International Journal of Obstetric Anesthesia·R A Isaacs, L Relton
Jul 20, 2016·International Journal of Obstetric Anesthesia·M Van de Velde, B Carvalho
Sep 20, 2016·International Journal of Obstetric Anesthesia·Robin Russell
Nov 22, 2016·Anesthesia and Analgesia·Carolyn F WeinigerSharon Einav
Mar 24, 2017·Obstetrics and Gynecology·UNKNOWN Committee on Practice Bulletins—Obstetrics
Feb 22, 2017·Clinical Obstetrics and Gynecology·John C Markley, Mark D Rollins
Jan 31, 2017·Anesthesiology Clinics·Michael G RichardsonCurtis L Baysinger
Nov 1, 2018·Journal of Anesthesia·Nobuko FujitaYasuko Nagasaka
Feb 26, 2019·Obstetrics and Gynecology·UNKNOWN American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics
Jul 9, 2016·Journal of Perinatal Medicine·Michael Heesen, Markus Klimek
Jun 20, 2018·European Journal of Drug Metabolism and Pharmacokinetics·Jing ChangMa-Zhong Zhang
Aug 7, 2017·F1000Research·Marie-Louise Meng, Richard Smiley
Sep 11, 2019·The Journal of Obstetrics and Gynaecology Research·Qiuju ChengHang Tian
Oct 2, 2020·Current Opinion in Anaesthesiology·David E Arnolds
Jan 20, 2021·Der Anaesthesist·Dorothee H Bremerich, Susanne Greve
Apr 23, 2021·International Anesthesiology Clinics·David E Arnolds, Barbara M Scavone
May 25, 2021·International Anesthesiology Clinics·Emily BuiKatherine M Seligman
Feb 23, 2021·BJA Education·J GoddardL Vinayakarao

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