Patient Controlled Analgesia
Remifentanil is a morphine-like painkiller. It is not officially registered as a painkiller for labor but has been used for this purpose for many years. Remifentanil can only be used if you choose it and understand its benefits and drawbacks.
Remifentanil works quickly and is administered through an IV. You can control the dosage yourself using a push-button (PCA). The infusion pump is secured, allowing you to administer pain relief within a safe, pre-set maximum dosage. It is recommended to press the button when a contraction begins.
During the pushing stage (expulsion phase), Remifentanil must be stopped. It exits the body quickly. This is necessary to remain alert, push effectively, and to prevent the baby from being born under the influence of Remifentanil.
For the first hour after starting Remifentanil, a healthcare provider will remain in the room to monitor the condition of both you and the baby. You must
not be left alone while using Remifentanil. If your partner or anyone else in the room wishes to leave, which would result in you being alone, discuss this with the nurse.
Advantages
- Easy administration (IV)
- Pain relief for serveral hours
- Rapid onset of action
- Rapid elimination (when pushing begins)
- Self-dosing with PCA
- Quick recovery of alertness after stopping
Disadvantages
- Drowsiness
- Restricted from getting out of bed due to fall risk
- Impact on breathing (shallow or insufficient breathing)
- Potential drop in oxygen levels (extra monitoring is performed --> blood pressure, pulse and oxygen saturation)
- Possible need foor supplemental oxygen
- Remifentanil also reaches the baby. This is not harmful, but Remifentanil must be stopped when pushing begins
- After a few hours, the effectiveness of Remifentanil may decrease due to the body building tolerance
Rare events
A rare side effect of Remifentanil is respiratory depression. If this occurs, the use of Remifentanil is immediately stopped, and counteracting medication is administered if needed. Remifentanil leaves the bloodstream quickly, allowing breathing to recover.
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