Patient Controlled Analgesia
Remifentanil is a morphine-like painkiller. Remifentanil has been used in the operating room for long. In the delivery room, during the dilatation phase, Remifentanil has been used more and more in recent years.
Because Remifentanil is not officially registered as a painkiller during delivery, Remifentanil can only be administered with your permission and after hearing and reading the advantages and disadvantages. Remifentanil is widely used in more and more hospitals. Adverse effects are very rare (<1:10.000).
Remifentanil is infused and works quickly. You can safely administer Remifentanil yourself via an infusion pump (PCA) and determine how much pain relief you need (with a safe set maximum dosage). You receive a push button in your hand to operate the pump.
Infusion of Remifentanil will be stopped during the pushing phase. Remifentanil will then quickly disappear from your blood. This is for you to be alert, to push effectively and to prevent the baby from being born under the influence of the Remifentanil.
In the first hour after starting the Remifentanil pump, one of the caregivers will be with you in the room continuously to monitor you and your baby’s condition closely.
Benefits
- Relatively easy route of administration (infusion).
- Provides good pain relief for a few hours.
- The effect is quickly noticable, but the effect will be gone quickly as well if you no longer want pain relief or if this is no longer medically justified.
- PCA, Patient Controlled Analgesia, means that you can dose Remifentanil yourself.
- You cannot overdose through a safely set pump with a maximum dose.
- As soon as you stop taking Remifentanil you will quickly be alert again.
(possible) Disadvantages
- You become sleepy during the administration of Remifentanil.
- It is better not to get out of bed. Because of drowsiness, you can fall.
- Remifentanil can affect your breathing.
- The oxygen level in your blood can decrease, for this you get intensive monitoring of your blood pressure, pulse and oxygen level. We might ask you to breathe deeply.
- Sometimes administration of oxygen is necessary.
- Remifentanil also enters the baby's bloodstream through your blood. This will not harm the baby’s condition. We will strive to stop the Remifentanil on time (when the pushing phase starts) for this reason.
- After a few hours of using Remifentanil, habituation occurs, which reduces the analgesic effect. This makes Remifentanil the most suitable option for pain management during the final phase of dilatation.
- When augmentation of labour is necessary (intravenous administration of Oxytocin), a second intravenous line needs to be placed.
Rare events
Breathing depression (‘apnoea’) in the mother and after birth in the child. In this case the administration of Remifentanil will be stopped immediately and counter-medication (Naloxone) will be administered. Remifentanil will disappear from the bloodstream quickly and the breathing frequency will recover.
Zoek folders
Print pagina
Download PDF
Grotere tekst
Kleinere tekst
Favoriet
Stuur door
