Non-regional analgesia for labour: remifentanil in obstetrics

Ronel, Ilai; Weiniger, Carolyn F.

doi:10.1016/j.bjae.2019.07.002

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…Of note, in many studies, Remifentanil was discontinued during the seconds stage of labor for fear of neonatal depression and expert authors advocate the availability of oxygen, naloxone and pediatrician when Remifentanil PCIA is used for labor analgesia. 19 Maternal safety…”

Section: Discussionmentioning

confidence: 99%

SP22.1 Remifentanil PCIA has no place in labor analgesia

Dewandre¹

2022

Invited Speakers

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usually feasible for an epidural catheter to be re-inserted in an emergency. It also requires the anaesthesiologist to explain this additional procedure to the patient and gain informed consent in a challenging situation. This extra workload i.e., explaining, gaining informed consent, and inserting a spinal anaesthetic, may be stressful for the anaesthesiologist. Also, they are now required to perform a procedure in a time-pressured and high-stakes environment. Performance anxiety may also play a part if the anaesthesiologist is very keen to avoid a general anaesthetic, for example, if they feel the patient's airway looks particularly difficult or the patient has pre-eclampsia and would therefore be at a higher risk of complications.Patient perspectives should also be considered. The author has found no published literature specifically relating to patient preference regarding epidural or spinal anaesthesia for emergency Caesarean section. However, it is reasonable to think that a patient who has a working labour epidural already has confidence in the technique and as a result, may feel more reassured with epidural anaesthesia for emergency Caesarean section as compared to alternatives.In summary, labour epidurals providing satisfactory analgesia should be considered for a top up to provide epidural anaesthesia for emergency Caesarean sections. In fact, this is one of the main benefits of siting labour epidurals in patients who are at a higher risk for Caesarean section and is a strong feature of obstetric anaesthesia practice using the principles of Planning, Preparation and Pre-emption. In addition, there are disadvantages to the alternative of removing the labour epidural and using a spinal anaesthetic. Furthermore, there are cost, environmental, anaesthesiologist, and patient considerations that may support the choice of epidural anaesthesia over spinal. REFERENCES1. National Institute for Health and Care Excellence (Great Britain). Intrapartum care for women with existing medical conditions or obstetric complications and their babies.

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Section: Discussionmentioning

confidence: 99%

SP22.1 Remifentanil PCIA has no place in labor analgesia

Dewandre¹

2022

Invited Speakers

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“…Most studies have not reported duration of remifentanil administration [ 18 ]. The maternal labor experience was reported using surveys and postpartum telephone interviews on women from the RESPITE study; 30 received remifentanil IV-PCA and 19 IM meperidine [ 1 ].…”

Section: Intravenous Opioid Labor Analgesiamentioning

confidence: 99%

“…While the recommendation of 1:1 nursing increases the chance of identifying respiratory depression [18], this may not be universally available. The difficulty to provide suitable staff monitoring is further compounded in the setting of increasing numbers of deliveries and insufficient concurrent staff increases [10].…”

Section: Remifentanil Safetymentioning

confidence: 99%

Update on Non-neuraxial Labor Analgesia

Karol

Weiniger

2021

Curr Anesthesiol Rep

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Purpose of Review This review will present recent updates for the use of non-neuraxial analgesia for laboring women. Recent Findings Non-neuraxial labor analgesia by nitrous oxide and intravenous opioids are described, and safety concerns with regard to remifentanil administration have been a major focus of recent studies. Fentanyl and nitrous oxide offer some efficacy, albeit less than remifentanil, however with a greater safety margin. Summary Women may request or require alternatives to neuraxial labor analgesia, in some cases due to concurrent comorbidities. Remifentanil offers the most efficacious alternative analgesia option; however, safety concerns may preclude widespread use.

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“…There are also other pain management options, like the use of opioids. Remifentanil is probably the most popular among opioids because of its short-acting characteristics [ 2 ]. It serves as an alternative to epidural anesthesia when an epidural is not feasible or desired.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study

Sobot Novakovic,

Cuk,

Rakanovic

et al. 2024

Cureus

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Background Some evidence indicates that maternal analgesia during labor may have adverse effects on neonates due to exposure to specific drugs or the potential effects of analgesia on the course of labor. We assessed the clinical outcome of term neonates born to mothers who received epidural analgesia (E) or systemic analgesia with remifentanil (R) during labor. Methods Data was collected retrospectively over one year. We have evaluated the medical records of 247 full-term neonates; 208 were born to mothers who received E and 39 to mothers who received R. Data on Apgar scores and neonatal complications (perinatal asphyxia, respiratory distress, infection, hyperbilirubinemia, and birth injuries), and average hospital stay were collected. Mann-Whitney U test, chi-square test, and logistic regression analysis were used where appropriate. Results The values of the mean Apgar scores between E and R at 1 and 5 minutes were similar (8.83 vs. 8.97, p = 0.252; 9.81 vs. 9.87, p = 0.762, respectively). The average length of neonatal hospitalization did not differ between groups (4.19 vs. 4; p = 0.557). The percentages of neonates with any complication were similar between groups (28.3% vs. 32.5%, p = 0.598). Neonates born by cesarean delivery (CD) had significantly worse outcomes than those born vaginally ( p = 0.008, OR 2.8, 95% CI [1.30, 6.17]). Conclusion We did not find a statistically significant difference in mean Apgar scores and neonatal complications between neonates who received epidural vs. remifentanil analgesia. An increased rate of complications in neonates born via CD was found. Future studies should have a larger sample size and be powered to detect associations in these findings.

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Non-regional analgesia for labour: remifentanil in obstetrics

Cited by 12 publications

References 23 publications

SP22.1 Remifentanil PCIA has no place in labor analgesia

SP22.1 Remifentanil PCIA has no place in labor analgesia

Update on Non-neuraxial Labor Analgesia

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study

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