Remifentanil patient controlled analgesia (PCA) in labour

What is remifentanil patient controlled analgesia (PCA)?

Remifentanil PCA is a form of pain relief that can be used in labour on the Rosie delivery unit. Remifentanil is an opiate pain-relieving drug like pethidine or morphine, but it is very short acting.

How is it given?

To use remifentanil PCA you will need to have an intravenous cannula (commonly known as a ‘drip’) placed in the hand or arm. The drip is connected to an electronic pump, which delivers a small dose of remifentanil when you press a hand-held button. The pain relieving effect usually occurs in approximately 30 seconds and wears off within a few minutes. The button should be pressed by you, and not by anybody else, when you become aware that a contraction is starting. The electronic pump is set up with a safety feature that limits the number of doses that you are able to give yourself every few minutes. The remifentanil PCA can be set up at any time during your labour. You are in control and get the drug only when you need it and the effects wear off quickly when you stop using it.

Who may use remifentanil PCA?

It is only offered and available to women and birthing people who have been advised not to have an epidural by an anaesthetist, because of medical conditions such as blood clotting disorders and some spinal abnormalities. It is not offered to those who, through personal choice, do not want an epidural and it is not used on the Rosie Birth Centre (the midwife led birth unit). It will not provide complete pain relief, but has proved useful for some women. Entonox (‘gas and air’) and TENS (Transcutaneous electrical nerve stimulation) machine may also be used at the same time to supplement pain relief.

Side effects of remifentanil PCA

Side effects of remifentanil PCA whilst you are using it include drowsiness, itching, nausea and lowered blood oxygen levels. Lowered oxygen levels may occur because your breathing rate may be reduced by the remifentanil and this means that you will require extra oxygen to breathe, which is given via a face mask. Remifentanil should be used with caution where you have received another opiate like pethidine within last 12 hours as the decrease in oxygen can be more significant. When you are using the remifentanil PCA your oxygen levels will need to be monitored at all times by your midwife, by an oxygen sensor on your finger. Your midwife will also measure your level of pain relief, drowsiness and blood pressure at regular intervals.

Remifentanil is currently not licensed for use in a PCA device and must be prescribed and set up by an anaesthetist. It is a drug that is commonly used by anaesthetists in the operating theatre.

Your baby’s heart rate will also be monitored continuously. Remifentanil does cross the placenta, and it may have similar effects on your baby that can occur with pethidine (such as reduced breathing rate and drowsiness). A neonatologist (doctor that cares for your newborn baby) is not routinely needed to attend the birth if you are using a remifentanil PCA.

Further information

Labour Pains - Patient Controlled Intravenous Analgesia (opens in a new tab)

For more information please contact:

Department of Anaesthesia

Box 93, Cambridge University Hospitals NHS Foundation Trust

Hills Road

Cambridge

CB2 0QQ

Tel: 01223 217434

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