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

Van de Velde, Marca,b

Current Opinion in Anaesthesiology: June 2015 - Volume 28 - Issue 3 - p 237–239
doi: 10.1097/ACO.0000000000000191

Purpose 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!

aDepartment of Cardiovascular Sciences

bDepartment of Anesthesiology, UZ Leuven, Leuven, Belgium

Correspondence to Marc Van de Velde, MD, PhD, EDRA, Professor of Anesthesiology, Department of Cardiovascular Sciences, Section Anaesthesiology, Catholic University Leuven and University Hospitals Leuven, Herestraat 49, B - 3000 Leuven, Belgium. Tel: +32 16 34 42 70; fax: +32 16 34 42 45; e-mail:

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